!v:,^ m ■w • ••.■■: ■wy?; r !•>.■/VA.l ^.-s 7 -tf'.-.iV- i'iityS >&.$•-$' ;5^r ■ '•■ »VT'r ■s.:.pi3,fii!8i *:®&3 «* ' A*tf: INAUGURAL DISSERTATION^^ ON THE DISEASE PRODUCED BY THE BITE of a MAD DOG, OR OTHER ''-< if RABID ANIMAL:**} { SUBMITTED TO THE EXAMINATION OF THE Rev. JOHN EWING, s.t.p. PROVOST; THE TRUSTEES and MEDICAL FACULTY O F T H E UNIVERSITY of PENNSYLVANIA, ON THE ELEVENTH DAY OF MAT, 179.2, FOR THE DEGREE OF DOCTOR os MEDICINJr, —......VL___ / ^J$^\t ^ JAMES MF^fiF. ft, Mi ^ ^ \ OF PHILADELPHIA. V \ * + v\ V' >■ N C ' ---------------- ■ THE POISON KILLS, ^^/i ^' THE BITE CONVEYS JT, DtAl 11 LLRKS IN TKE TE1VH. " "-• C Lucan. P barf at. PHILADELPHIA: P.iintf.d by THOMAS DOBSON, at the Stone-House, Second-Street, m,dcc,xcii. TO BENJAMIN RUSH, M. D. PROFESSOR of the INSTITUTES, AND OF CLINICAL MEDICINE, IN THE UNIVERSITY of PENNSYLVANIA. JL 0 whom can the Jollowing pages be inferibed with fo much propriety, as to you, honored fir, by whom myjludies in medicine have been directed ; andjrom whofe publication, I received thefirfl hints which led me U adopt the principles contained in this differta- tion ? Be pleajed, therejore, to allow me to dedicate ■ this effay to you, as ajmallmark of rejpect Jrom, much ejleemedfir, your affectionate and grateful pupil, JAMES MEASE. Philadelphia, May 7, 1792. to ANDREW MEASE, M. D. of sfrabane, ireland. Honored six, Ji L THO UG H related, yet perfonally unknown? I have taken the liberty to infer ibe to you, likewife, the inaugural fruits of myjludies in medicine : at the fame fitne, I beg leave to exprejs the highfenfe 1 entertain of the honour you have conferred, by your inflructing and friendly correfpondence, upon your affectionate nephew, JAMES MEASE. Philadelphia, May 7, 1792. TO Mr. JAMESMEASE. My bear friend, 1 Cannot confent to the publication of your ingenious dijfertation, without requejling you to allow me room enough in your prejace, to exprejs the great pleajure I derived Jrom reading it. It will be reforted to hereafter as a repojitory of Jacts and opinions upon the dijeaje of which it treats. I have only to add my bejl wifhes for your Juccefs Mnd ujejulnejs in life ; and to affure you, that Ifhall long retain an affectionate Jenje of the zeal and fide- lity, with which you have difcharged your duty to your friend and preceptor, BENJAMIN RUSH. Philadelphia, May 8, 1792. -US' i ■ ' TV. vX PRE FACE. JlrfVER fince the inftitution of Univerfities and Colleges, the publication of a thefis has generally been the condition, by which the higheft honor in medicine was obtained. Cuftom, and the ftate of learning, has hitherto made it ufual to publifh this fpecimen of the ftudent's abilities, in the Latin language. But this has ceafed to be the general medium of the communication of the learned to the world, and almoft every author writes in his native tongue. As the Eng/ifb language is at prefent underftood by as great a part of the globe as any other,the Univerfity of Pennfylva- nia have wifely refolved to leave it to the option of the candidate, to write either in the Latin or Englijh language. By delivering my fentiments in a language not generally intelligible, I might indeed be fuppofed to exhibit proofs of my learning; yet as a Jew only would be qualified of judging of its merit, I willingly difpenfe with the honor I would derive from my dhTertation tyeing read by thofe men, for the more humble wifti of being generally ufeful to my countrymen. This can only be effected by publifhing in my native language, and this alone would be a fufficient in .iuce- PREFACE. inducement to make it the medium of communicating my fentiments to the public. From the firit period of my ftudies in the fcience of me- dicine, no difeafe that I met with in books, engaged fo much of my attention as that confequent on the effects of the poi- fon of a mad dog, or other rabid animal, on the human body. I early deemed it an object worthy of enquiry -, but the primary caufe of my attention being immediately called to the complaint, was in confequence of a paragraph being inferted in almoft all the newfpapers in this city, in the month of January, 1790, taken partly from Boerhaave, in which the difeafe was defcribed in the moft erroneous and dreadful manner; and the Tonquin remedy recom- mended at the fame time, as an infallible prefervative and cure. The confideration of the very great uneafmefs the piece alluded to, would excite in the minds of the people, together with the certain death that would enfue from an improper confidence being placed in the medicine, induced me to pay an immediate attention to the inveffigation of the difeafe. The very publication, however, would have been fufheient to take away any confidence that might have been put in the remedy it recommended, or any other whatever, if the affertions reflecting the difeafe had been credited. The very numerous cafes that I had met with in authors, of the failure of the Tonquin remedy, and a per- fuafion of its in efficacy, grounded from reafoning on the known qualities of the ingredients which enter into its com- pofition, as fuited to counteract the fymptoms they were in- tended PREFACE. ft induced me to determine at once as to the total inefficacy of this once famed remedy. In a fhort effay on the difeafe, which I drew up and inferted in the American Mufeum for August, 1790 *, I combated the many erroneous opinions with refpect to it, and particu- larly attended to a comparifon of the different methods of cure hitherto employed. On a contemplation of the whole of thefe, I was convinced of their total inefficacy, from their uniform failure, in every cafe where they had been ufed. None feemed more rational, of any that had hither- to been untried, than that hinted at by Dr. Rum, in an effay on the tetanus, contained in his volume of Medical Inqui- ries and Obfervations, published the preceding winter. In the appendix to that effay, he more particularly no- ticed the great fimilarity between tetanus, and the difeafe confequent on the bite of a rabid animal, and advifed the fame tonic remedies in the latter, which he had found fo fuccefsful in the former. In the effay, above alluded to, I concluded with declaring my readinefs to adopt the opinion of Dr. RuOi, with regard to the propriety of the application of the fame mode of treatment to both dif- eafes, which, from reafoning on their caufes and the phoe- nomena they exhibited, I was fully convinced was founded in truth. Repeated reflection on the fame subject, fince that pe- riod, has ferved to ftrengthen me in the idea of the truth of the opinions I then delivered, and has induced me to take a a much * Vol. viii. p. 68. vi PREFACE. a much more enlarged view of the subject than I firft in- tended. How far I have fucceeded, does not become me to fay; the decifion of this question refts with the public— I do not pretend to infallibility, and therefore declare, that if, from future obfervation, and maturer judgment, I fhall find that a fmgle opinion advanced in the following pages, is erroneous, I will readily retract it. I fhall there- fore, as chear fully receive any objections offered to my opinions, as I fhall be made happy by obfervations or remarks tending to confirm them : and whether they are offered in print, or I-am privately informed of them, they fhall be duly attended to, and anfwered in their refpective modes of communication. As to the language of my differtation, I have endeavour- ed to be as clear and perfpicuous as poffible; and although I was fully fenfible, how much elegance of ltyle would in- fluence the opinions of fome, as to the merit of the work; yet this was not fo much attended to as the matter. I alfo reflected, that however pleafing a well turned period may be to the ear at the time of its perufal; that finally it is found argument which will ftand the test of philofophical examination. I fhall conclude this preface by remarking, that not* withstanding we are indebted to accident for many of the moft important difcoveries in medicine, as well as in the fciences in general,it is neverthelefs an humbling confidera- tion to human pride, that it is feldom any truth is perfectly eftallifhed, until all the errors relating to it, are firft point- ed PREFACE* v ed out. If, therefore, my labours have been attended with no pofttive good, but are merely negative, by fhewing the fallacy of many fuppofed truths, concerning the fubject of my differtation, I fhall think myfelf fully rewarded. I may, by thefe means induce others to extend their refearches, and finally become the indiretl instrument of flopping the ravages of a difeafe, hitherto the moff, fatal, and certainly the mofl dreadful, to which human nature is fubject. INAUGURAL DISSERTATION. X HE fatal effects that have hitherto followed the action of the canine virus on the animal fyftem,have, in every age, occafioned it to be justly viewed with horror. Indeed, whether we confider the peculi- arity of the fymptoms, or the total inefficacy of the medicines which have been ufed for its re- lief, no difeafe to which human nature is liable demands a more ferious attention. The variety of opinions entertained by phyficians reflecting this difeafe, and their very great contradiction, is the fureft proof of the little knowledge we poffefs con- cerning it. In the following diltertation I lliall be under the neceflity of oppofing many of thefe opinions, but with what fuccefs, the fequel of this effay must difcover: without, however, any further preface I lliall enter on my fubject. A HISTORY r * ] HISTORY OF THE DISEASE. IN imitation of the practice, followed by al- molt every writer on difeafes, it will be expected, that I mould enter into the antiquity of the one that I have chofen for the fubject of this differta- tion. On this as well as on all other occafipns which sadmit of doubt, or an opportunity for cavilling, there have been endlefs difputes: but as it ra- ther affords matter of curious fpcculation, than a deduction of any practical utility, I lliall decline entering fully into the difcuslion of the queftion^ efpecially, as in my opinion, it can be very easily decided. Respecting the firft appearance of the difeafe, I deem it impoflible to fpeak in a pofitive man- ner. The mod probable opinion is, that as dogs have exifled in all ages, this difeafe was of very an- cient date. From the circumftance of its not being mentioned by Hippocrates, fome authors, as Plu- tarch, and after him M. Le Clerc *, have infilled on its origin at a later period; viz. in the time of Afclepiades. * Lc Clerc, Hift. de la Med. part ii. p. 463. r 3 ] Afclepiades, who was physician at Rome, in the 62d year of the Christian era.—But although it is not noticed by Hippocrates; yet, as Van Sweiten* obferves, this " amounts to no proof that the dif- " temper was not in being in his time. It might " perhaps be lefs frequent in the parts which were " inhabited by Hippocrates ; fince Aurelian f tells " us, that this is a diflemper, not alike common to " all countries." I mall hereafter mention alfo, that, in fome places, the difeafe did not appear for a long time, and that others arc entirely exempt from it, as far as we have any account, to this day. But although no particular time can be afcertained at which the difeafe appeared, yet we have the most pofitive proof of its having been known at a much earlier period than that of Afclepiades. Homer, in the ninth book of the Iliad J, introduces Ulyffes, when on an embaffy to Achilles, to requefl: his re- turn to the Grecian camp, comparing the fury of Hector to the rage of a mad dog. Achilles, it is well known, ftudied medicine under Chiron ; . and therefore, as Dr. James justly obferves, "was the " more capable of receiving an idea of the mifchief li Hector did to his countrymen by this meta- A 2 " phor." • Comment, on Boer, aphor. 1139. Dc Morb. Acat. lib. iii. p. 239. X Line 337 C 4 1 " phor*." From this, it appears evident, that the difeafe is of very remote antiquity, as it cer- tainly must have been known even before the time of Homer, although he is the firft author from whom we have any account of it. This difeafe is generally faid by authors, to be peculiar as an original affection to the three fpecies of the genus cams; viz. dogs, wolves, and foxes, No other animal, upon which any accurate obfer* vation has hitherto been made, has been known to be feized with it in a fpontaneous manner, except thofe mentioned, although all are capable of be- coming affected with it, in confequence of a bite, from any of the formerf. Cats, indeed, are faid to have * Philofoph. Tranf. vol. XXXVIII, p. 249. In the 8th and 13th books of the Iliad, Hector is alfo compared to a mad dog, both by Teucer and Neptune. f Throughout the whole fcale of animated nature, we may ob- ferve a general law prevailing, whereby certain difeafes belong to certain-ages, conditions,'and kinds of animals. Thus the prefent difeafe is peculiar to the canine genus, as an original affettion, al- though man as well as other animals are liable to be affected there- with in confequence of a bite; on the contrary, there are fome difeafes to which mankind are peculiarly obnoxious, and which it is impoffible to communicate to brutes. Thus, in repeated experi- ments, Mr. Hunter could never inoculate a dog, bitch, or an afs with the venereal difeafe. Treatife on the venereal difeafe, chap, i.- fedl. 6. The fame obfervation is likewife applicable to man : the Indians in Nantucket, many years ago, were carried off by difeafes which never r s ] have been feizedwith it fpomaueoufly; and the ex- cellent Morgagni remarks*, that after dogs, he knows of no animals more liable to the difeafe than cats. If this be true, and thefe animals are feized with it originally, independent of a bite, an inquiry immediately offers itfelf, why other ani- mals belonging to the fame genus are not affected with it in a similar manner, f Aurelian mentions its appearing fpontaneoufly in leopards: but I ap- prehend, from the fame obfervation having never been made by any fucceeding writer, and his not having sufficient opportunity to make the remark, that it is without foundation, and only taken for granted, as a probable circumflance; "as thefe ani- " mals, conflantly dwell in thecaves of greatwoods, " remote never affected the white inhabitants among them. Dr. Lining tells usf that the negroes were never afflicted with the yellow fever in South Carolina, although conftantly around the fick; and thefe again have difeafes peculiar to themfelves, to which the wliites arc entire ftrangers. * Morgagni on the feats and caufes of difeafes. Letter LXI. art. 15. •f- This inquiry was fuggefted to me by that excellent phyfician, and learned natural hiftorian, Dr. Samuel L. Mitchell, of the ftate of New York, in a letter which I received from him, dated the 29th of January, 1792. " The genus fells," fays lie, " to which the domeftic cat be- longs, lias a great number more of fpecies than the cants, and it is not a little ftrange, that though it is reported that the houfe cat has been originally affected by Hydrophobia : yet, that wild-cats, lions, leopards, panthers, and other fpecies of the genus fhould never have it, but in the derivative way.". r s ] " remote from human fociety, and if they happen " to fix their jaws upon men, it is commonly with " the fatal view of flaughtering them *." To enter into an investigation of this inquiry, would lead me too far from the main object of this differta- tion, and would, I fear, from the difficulty of ob- taining a sufficient number of facts, be attended with but little fuccefs : I fhall, therefore, leave it for thofe difpofed to engage in the undertaking, and pafs on to another in which I am more inte- relted: I mean an examination of the question, whether the difeafe, which we are confidering, ever arifes fpontaneoufly in the human body, without the bite of a rabid animal ? Notwithstanding, the relation of many cafes, by different authors, of fpontaneous hydropho- bia, I doubt much whether it ever appeared as an original difeafe. In refpect to fome of them, it may be with propriety questioned, whether the fymp- toms they defcribed pertained to the actual dif- eafe. For, from a careful perufal, and attentive examination of the many hiftories on record, the dread of fluids appears to me to be no more than a fymptom of an original difeafe, which, from its being particularly urgent, has been mistaken for * Van Swieten Comment, Aphorifm 1132. [ 7 ] an idiopathic affection. Thus Dr. Innes ' has given an account of a hydrophobia attending an inflam- mation of the stomach ; but the impropriety of the name will at once be evident in this cafe, as there muft have been an equal dread of both folids and liquids, on account of their increafing the difeafe f ; but as the great third under which the patient laboured, induced him only to call for drink, which from his fenfations he knew he could not fwallow, the averfion from it, was the caufc of the difeafe being ftamped with the name. In other cafes alfo, where the difeafe was faid to have appeared without a bite, I am convinced that they were no more than cafes of Tetanus, both from the caufes that induced them, and from the known circumftance of an averfion from fluids taking place in that difeafe. Mr. Arthaud t, re- ; lates the hiftory of a fpontaneous Hydrophobia, which is an exact defcription of Tetanus.—It was brought on by the perfon being expofed to the alternations of violent heat in the day, and cold and damp at night, in the ifland of Hifpaniola, which in that ifland, as well as others in the Weft-In- dies, • Edinb. Med. EfTays, Vol. I. p. 226. f Gaftritis,—pyrexia typhodes, anxietas in epigaftrio, ardor et dolor, ingejlis, quibuflibet auclus, Sec. Oil. nofo. method, genus 15. J Recherches fur la malad. Epizootique de Saint-Donvn^u^ VOI. I. p. 32». C 8 D dies, are among the moft frequent caufes of this difeafe. In other cafes of this fuppofed difeafe, they may be with as much propriety termed fits of mania, or violent delirium in fevers. Thus Van Swieten relates the hiftory of a man from Boerhaave, who, after being expofed to a fcorch- ing fun, and drinking at the fame time a quantity of fpirituous liquors, fell into a moft ardent fever, and with great horror refufed all liquors that were offered him *. Sauvage f alfo mentions a cafe, where a malignant remitting fever was atttended with a perpetual delirium, convulfions, and dread of fluids. Dr. Mead J relates, that he faw palpita- tions of the heart, accompanied with a dread of fluids ; but here, in my opinion, it was a mere fymptom of hyfteria, in which difeafe the fame au- thor alfo obferved it to take place. The difpofition to the marvellous, which is fo fully fhown by almost all the old writers in medicine, their extreme cre- dulity, and the litttle attention generally paid to- wards inquiring, any further than the furface of things, have been another caufe of their mistaking the real nature of this difeafe. Many of them likewife, as Dr. Vaughan || remarks, " are fo defi- " cient * Van Swieten, Comment. 1130. ■f Sauvage Nofolog : method. Vol. I. p. 354. J Meads'Works, p. 81. || Vaughan's Cafes, and Obf. on the Hvdroph. p. 40. 4 [ 9 1 " cient in point of accuracy, as to leave the reader " in fufpenfe as to the fact for which he confults " them," and therefore deferve any other name, as well as that of Hydrophobia. From the ignorance of the patients alfo, I am inclined to imagine, that many cafes, faid to be fpontaneous, have actually proceeded from the bite, which having been either flight, or received at a consider- able diftance of time, has been overlooked, and the true caufe confequently neglected. In other inftances, a difficulty of deglutition, or fpafmodic affection of the mufcles of the throat fimply, has been magnified'into a hydrophobia: this appears to me to be the explanation of the cafe related by Marcellus Donatus f. A violent furfeit in a boy, from eating beach nuts, caufed a fever, delirium, fpafmodic affections, &c. is alfo faid to have been accompanied with a dread of water {. But this appears to be no more a cafe of the dif- eafe in question, than the dislike to water from eat- ing an unripe perfimmon, or any other fimilar astrin- gent vegetable, deferves the name of Hydropho- bia. The difagreeable effect of thefe fruits on the mouth and throat is well known, and the beach nuts appear to have induced a fimilar ftate ;—a delirium accompanying the latter cafe, made the B averfion • Marcellus Donatus, lib. iv. chap.i. f Med. Mufeum, Vol. I. p. 98. [ 10 "1 averfion from drinking more remarkable, and more nearly to refemble the original difeafe depending on the virus. But why fhould this difeafe be thought to arife fpontaneoufly, any more than the fmall pox, vene- real difeafe, or any other depending on a fpecific contagion ? I will not deny that an averfion from fwallowing fluids has occurred in no other dif- eafe, but that proceeding from the bite of a ra- bid animal. I have already mentioned its oc- currence in tetanus, hysteria, and other dif- eafes. All I contend for, is, that fuch cafes as are called fpontaneous inftances of the difeafe, are not accompanied with the other fymptoms which fo characteriftically defignate the idiopathic affection. The fame mistake has been made, in calling every emaciation of the body a conjunc- tion ; when, accurately fpeaking, and according to the definition of the difeafe, no fuch emacia- tion deferves the name of confumption but that which is accompanied with a local, though not pri- mary affection of the lungs, constituting the dif- eafe, and understood by physicians by the name of Phthifis Pulmonalis. The falfity of the idea of an actual and idiopa- thic Hydrophobia arifing in the human body, with- out r » J out the action of contagion for its production, I hope is now evident, and I fhall therefore proceed to deliver the HISTORY OF THE SYMPTOMS. AT various, and indeterminate periods of time, after the introduction of the poifon, by a wound in any part of the body ; it moft commonly begins to fhew itfelf, by fharp pains in the place where it was received, fhooting in every direction to the neigh- bouring parts, and frequently to the stomach, throat, and bowels. At the fame time, there is a fenfe of laflitude and languor, and an averfion from mo- tion, fhewing evident marks of a general debility, fuch as ufually precede the attack of a febrile affection. The flying pains continue to increafe, and feizing the urinary organs, create a difficulty and heat in difcharging the urine. A pain is alfo felt at the Jcrobiculus cordis, or pit of the stomach ; and a fenfe of constriction about the fauces and throat, occafioning a difficulty of fwallowing. Thefe fymptoms are accompanied, or immedi- ately fucceeded, by reftleffnefs, and anxiety about the precordia ; occafioning a frequent change of posture, and fighing—and the moft exquisite fen- fibility prevails over the whole body; particularly in r 12 ] in the organs of fenfe ; light becomes painful to the eyes, a fudden noife occafions involuntary start* ings, and the air, although to perfons in health it be of an agreeable temperature, feels cold and difagreeable. If at this time, or before, the per- fon incline to fleep, it is fhort, disturbed with frightful dreams, and on awakening he is apt to fall in to flight convulfions. The eyes alfo are fierce and penetrating*, the countenance exhibits a pecu- liar anxietyf, and a fenfe of defpair; and frequently changes' its afpedt p a copious fecretion of faliva, now takes place j but notwithftanding the fick are troubled with a very great thirst, the difficulty in fwallowing, which before this time could be easily overcome by a firm refolution §,nowbe* comes fo great, that an attempt to fwallow, efpe- cially liquids of any kind, whether by compulfion, or with a view of mitigating their thirst, never fails to excite the moft difagreeable fenfations; they are feized with violent agitations; a ball as it were rifes from the stomach up to the throat, and feema to threaten a suffocation ; the mufcles of the face become varioufly contorted, and the exertion is frequently fucceeded by convulfions. Vomitings at this time frequently take place j and the con- conftriction * Vaughan's Cafes and Obf. on Hydroph. p. 6, 24. f Med. Tranfaft. vol. II. p. 46. J FothergiH's Works by Lettfom, 4to. p. 353. § Med. Comment. Vol. II. p. 304. [ i3 1 ftrictionabomthebreaft, and the difficulty of breath- ing become fo extreme, that if a blast of air blows on them, they are feized with the greateft diftrefs, Cover their mouths, and feem ready to expire, as if itruggling for breath. A fever fometimes occurs, preceded by flight fhiverings, but it is in general very mild, and does not often appear. The pain in the bitten part, at this period of the difeafe, has generally vanifhed; and a numbness*, or paralytic affection off it fucceeds, with an increafe of the violence of every fymptom already mentioned. A recumbent or horizontal pofture aggravating their complaint X: the fick commonly either fit up, or walk about; the flowof faliva becomes extreme- ly troublefome from its vifcidity, and the inability toexpel it, the breathing is very laborious and diffi- cult, and being quickly repeated, and attended with a constant and peculiar kind of hawking, in order to evacuate the faliva, has been thought to imitate the barking of dogs. The irritability of the fyf- tem has by this this time arrived to fuch a morbid degree, as occafions it to be thrown into convul- fions by the flighteft caufes, but by none in fo ready • Edin. Med. EfTays Vol. V. part ii, p. 97- Philofoph. Tranfact. abr. by Lowthorp. Vol. III. p *8 8, f Mead's Works, p. 66i. J Hamilton's Remarks, p. 196. Mem. Med. Society Lond, Vol. I. p. 243. Vaughan's Cafes, p. 23 C 14 1 ready a manner, as an attempt to fwallow fluids; nay, the bare mentioning of an action fo recent in their minds, and feverely painful in its confe- quences, excites a return of their fymptoms, c\nd occafions the greateft diftrefs *. Even the fight of water or other fluid, or of any thing having the least refemblance to it, fuch as a looking glafs, or any white fubftance, whereby an occafion will be given for the renewal of the idea of their former pain, will have the fame effect. At this period alfo, folids become equally difficult to fwallow, and the bare mention of even them has excited the fame convulfions as that of fluids f. In this advanced stage of the difeafe, when the general difturbance has prevailed for fuch a length of time ; flight fits of delirium occafionally occur ; the patients frequently forget their friends and relations. This delirium is attended with a constant talking ; but even at this time, they have the power of fummoning themfelves ; and foon becoming collected, return rational anfwers to the queftions propofed. At other times, for the chief part, they have the moft perfect enjoyment of * Hoc tempore quoque in homnibus priafmus incidit, cum fcroti contra&ione, & feminis involuntaria frequente emiflione. f Edinb. Med. Commen. Vol. I. p. 304. Mem. Med. Soc*. Vol.1, p. 260. C -5 ] of their fenfes to the last. The pulfe, which du- ring the former period of the difeafe, was but little altered from the healthy standard, except being lefs strong, now becomes evidently weak, qui,ck, and intermitting. Falfe vifion, dullnefs of fight*, together with adilatation of the pupilf, and fometimes actual blindnefs J, now appear ; quanti- ties of faliva are collected in and about the mouth, and being mixed with air taken into the lungs, put on a frothy appearance, which the patient is con- stantly endeavouring to get rid of, by wiping it with a handkerchief, or fpitting it about with great force. The voice becomes very hoarfe, and at the fame time the convulfions increafe in frequency and force over the whole body. Spafmodic affections take place in the mufcles of the face, occafioning violent contortions, and the moft hor- rid affemblagc of features; and inthemufcles appro- priated to moving the lower jaw, inducing invo- luntary quafhing,and a grinding of the teeth, which fome have construed into a defire of biting. The strength now fails—the extremities be- come cold, and death in a fliort time relieves the miferablc • Med. Communications, Vol. I. p. 215. f Meads' Works, p. 660---Hamilton's Remarks on bite of ; mad dog, Lond. 17S5, p. 199- + Med. Obf.and Inq. Iond. Vol. III. p. 368. C i« ] miferable patient from his fufferings; fometimes expiring with convulfions, as if from a suffoca- tion, and other times in a calm and placid man- ner. The above, is the common progress and order of the fymptoms, produced by the canine poifon* on the fyftem. But a variation from them often takes place in different perfons, which it is pro- per I fhould mention, previoufly to proceeding any i further on the fubject f. Notwithstanding a pain in the bitten part, generally is the firft fymptom of the action of the poifon, yet in fome cafes it has been entirely abfent, and where the perfon has been ignorant of the caufe f A circumftance that I have omitted mentioning in the Hiftory of the fymptoms, was the terror the patients are faid to be ftruck with at the fight of a dog; becaufe it is only mentioned in thofe cafes where it is faid the perfons were acquainted with the caufe of their difeafe, and by therefore dwelling on the idea of their fufferings, may very readily have conceived in their delirium that a dog was prefent, which they have accordingly defired might be taken away. I can readily affent, however, to another thing commonly taken notice of, viz. the convulfions excited by the barking of a dog; but this arifes folely from the very great fenfibility of the fick, by which this, or any other fudden noife, as (hutting a door, a blafl: of wind, &c produce the fame effects. 4 T >7 1 caufe of his fymptoms it has never been mention* ed, through the whole courfe of the complaint. This was the cafe with Mr. Bellamy, as related by Dr. Fothergill* ; alfo with the perfon whofe hiftory is related by Dr. Lifter -j-, and with many others whofe cafes are on record in books of medicine. A Confiderable variety, is alfo obferved in the firft fymptom of the general affection, even when this is not fliewn by the pain in the bitten part. In fome, the urinary organs are firft affected {, while in one of Dr. Vaughan's § patients as well as Wilbraham's ||, and others, the stomach, bowels, and throat, were the parts on which the difeafe firft Ihewed its effects. The difpofition which has hitherto almost uni- versally prevailed among authors, to divide difeafes into stages, has alfo extended itfelf to the one whofe hiftory I have now delivered. Each of thefe ftages is defcribed as having a peculiar and appropriated fet of fymptoms, never occurring in C any « Fothergill's Works 4to, p. 353.—Med. Commun. Vol. I. p. 214. f. Philofoph. Tranladf. Vol. III. p. 277. % Fothergill's Works, p; 353. ^ Vaughan's Cafes, p. 4. || Philofoph. Tranfact. abridged, Vol. XLVII. p. 413. .[ 18 1 any other stage, and which uniformly remained the fame in all cafes. But had thefe defcriptions been drawn up from the many accurate relations of cafes of the difeafe on record, rather than copied from preceding fyftematic writers, it would have been found, that a difference of circumftances, as thofe of conftitution, and age, would have made a materi- al difference in the progress of the fymptoms, in dif- ferent perfons. This variation of the fymptoms in the prefent difeafe, has already been pointed out, and is particularly obfervable in the pain at the bitten part, ^^Mcb00mough. generally a fymptom of the firft stage, frequently does not appear through the whole courfe of the difeafe. Dr. Duncan* has divided the difeafe into stages, though in a fomewhat different manner from other authors. But although I have the highest refpedt for the authority of this excellent physician, from whofe industry and labour, I have derived much information, yet I cannot affent to his divifion, as I do not find it fupported by the cafes on record. The affections of the vital Junctions, which are faid by him to mark the commencement of the Jecond Jiage, are very generally among the firft fymptoms of the * Heads of Ledum on the Theory and Practice of Med. Edinb. 1785, p. 227. I >9 3 the difeafe : for as Dr. Seleg obferves, " It begins " with the diforder before the dread of water takes " place, increafes with it, and attends to its last " ftage, till at last the patient expires under it.*" The affection of the mental faculties, which is faid to mark the third ftage, is an equally uncertain fign whereby to defignate any particular period. For while a delirium fometimes takes place very early in the complaint, at other times, it never occurs during its whole courfe, the fick having the moft perfect enjoyment of their fenfes f ; and moft com- monly the mental faculties are in a fuperior ftate of excitement. This is fhewn by their quick per- ception, amazing acutenefs of underftanding, and the rapidity with which they anfwer queftions. Thus, Dr. Howman || gives us a cafe of a patient, whofe " reafon was all along very good, and as " fome obferved, better than in health." Dr. Vaughan likewife remarks in the hiftory of the third perfon whofe cafe he relates, that " His in- " tellectual faculties feemed quickened by difeafe." For this reafon, therefore, that the divifions hi- therto attempted by authors, were in a great C 2 meafure * Medical Mufeum, vol. II, p. no, Lond. 1781. •f London Med, Obf. and Enq. vol. III. p. 356.—Hamilton's re- marks, p. 196.—Vaughan, p. 29. U Philof. Tranfaft. vol. HI. p. 281. [ So ] measure arbitrary, not being bounded by any particular fet of fymptoms, as well as from a con- viction, that if it were poffible to eftablifh them, no ufeful deduction could be inferred from them in the removal of the dijeaje, I deter- mined to take no notice of them, but to mention the fymptoms, in the order they appear moft gene- rally to follow. From a confideration of the variety of the fymp- toms, and the ftrong manner in which they are marked, it would, on a firft view, feem very pro- bable that the greateft advantage or infor- mation would be derived refpecting the patho- logy of the difeafe, from the diffection of the bodies of thofe dying of it. Accordingly, we have very numerous hiftories of the appearances after death, related by many authors; but on account of their extreme variety and want of uniformity, and the circumftance of their all being the confequence, and noways connected with the caufe of the dif- eafe, it is impoffible to draw any conclusions from them. The excellent Morgagni, although he relates the diffections of many cafes, does not pre- tend to draw any conclusions from them, but ob- ferves, that as " there are many things in which " thefe patients, while living, differ one from an- " other, fo there are not fewer, but even more, " in L 21 J " in which their bodies differ after death *." The violent convulfions that are obferved to take place in the mufcles of the throat when an attempt is made to drink, constituting one of the moft re- markable fymptoms of the difeafe, naturally turned the attention of physicians towards the examination of that part aftej death. A flight degree of in- flammation, or rather rednefs in the superior parts of the trachea or windpipe, has fometimes appear- ed, but in others no marks of any fuch rednefs has been found, and where it occurs, as Van Swieten obferves, " it rather feems to-be an effect or con- " fequence of the diftemper, than a productive " caufe of it," arifing from the frequent convulfion of the parts. The epiglottis has alfo been obferv- ed to be crifp and dry in fome cafes: but a more general circumftance. attending after death, is the quick tendency of the bodies to putrefaction. I fhall now proceed to the rationale of the fymp- toms, or inveftigation of the difeafe. First. The extreme Jenjibility of the whole fyftem to the external air, and the difpofition to be thrown into convulfions by flight ftimuli, is one of the * Morgagni, letter VIII, art. 30. r 22 ] the moft remarkable fymptoms attending this dif- eafe. To attempt a full explanation of it, would be a difficult, and I fear,an impracticable undertaking: but although the particular charge induced on the nerves, cannot be afcertained ; yet fo far we know, that the poifon by its action on thofe or- gans, deprives them of the power of performing their proper functions by which the above morbid fenfibility is induced *. Second. The theory of convulfions being fo very generally delivered by every pathological writer, needs no explanation in this place. Third. The Angular oppreffion and diflreffing anxiety at the praecordia, or round about the breaft, which occur fo early in the difeafe, and continue to opprefs the patient, merit a particular explanation. Dr. Heyfham f refolves them into an unequal determination of the blood from the veffels of the fuperficies to the larger ones near the heart and lungs; but we have no proof of this undue deter- miration * This date of extreme fenfibility to the air, has been remarked as far back by phyficians as the time of Aurelian and conftantly noticed by every writer on the difeafe: hence the patients were faid to labour under serephobia. f Differtat, inaug. chap. xi. C *3 ] mination ; and I am rather difpofed to afcribe them to the irritation of the nerves of the lungs, and: efpecially thofe of the bronchia, whereby their cavity is contrafted, and a morbid fenfibility indu- ced; hence the application of the air to their furface proves highly painful. A full diftenfion of the lungs, therefore, cannot take place, and this occa- fions a more frequent refpiration, which then be- comes in fome meafure voluntary, and of courfe very tirefome : anxiety will then follow, together with the difficulty of breathing, fo much com- plained of. The palpitations, afcribed by Dr. Heyfhamto the collection of blood, or to its unufual determination to the heart, are not owing to this caufe, but merely to the nerves of that organ partaking of the general irritation pervading the fyftem, by which they excite the heart to more frequent con- tractions. The occurence of the fame fymptoms in hyfteria, and other nervous diforders, and from the fame caufe, is a further proof of this opinion. No fuch fymptom, as a palpitation, takes place in thofe difeafes, where there are the moft unequi- vocal proofs of the heart being opprefled. In this cafe, a violent increafed action of the heart and arteries, which is fliewn by a full and hard pulfe, is the only confequence. Fourth, L fi4 ] Fourth. The violent pain experienced at the fcrobiculus cordis, or pit of the ftomach, appears to arife from the irritation of the nerves fupplying the diaphragm, whereby it is thrown into inordinate contractions. That this mufcle is affected, is render* ed alfo probable by the hiccoughing which fome* times occurs. How far the diaphragm is concern* ed in the affection of the throat, I will not pretend to fay. Dr. Vaughan, indeed, aflerts he was led to believe, that in " this difeafe a newfytnpathy " was eftabliflied between the fauces and diaphragm; " and that the latter was drawn into a moft fevere " fpafm, as often as any offending caufe operated " upon the former*." The connection, however, between thefe parts is certainly great, and was long fmce obferved. Heifter informs us, that in a cafe of inflammation of the diaphragm, he obferved the power of fwallowing deftroyed, and a difficulty of deglutition from a contraction of the diaphragm, we know takes place in a fit of hyfteria f. Fifth. One of the moft remarkable fymptoms attending this difeafe, which from the early notice taken of it, and the circumftance of its general predominance, has given a name to the difeafe, is * Vaughan's cafes and obf. p. 47. t Haller opuf. de mufc. diaph. No. 36. r «s i is the intolerable averfion, fliewn for the moft part, by thofe who labour under this difeafe, from wa- ter and fluids of all kinds. This has never as yet been fatisfactorily accounted for ; for which rea- fon, and becaufe its folutionwill tend to render the complaint of a much more fimple nature, than it hath hitherto been confidered, I fhall fpend fome time in inveftigating its caufe. The idea generally entertained by authors re- fpedting this fymptom, is, that it is owing to fome change induced in the fyftem, from the action of the poifon on it, whereby ^Jpecific dread of fluids is induced, independent of every other caufe. But I hope I fhall clearly prove, that it is entirely owing to an affection of the throat, from whofe morbid fenfibility, and the inability of fwallowing, together with the pain excited, this fymptom feems wholly to originate. Salius Diverfus, indeed, was the firft who dif- believed this doctrine, and came nearer the truth than any of his predeceffors, by referring the aver- fion from drinking to the circumftance of thepatients finding themfelves worfe after taking any fluid*. Dr. Whytt f likewife entertained a fimilar opinion: for he obferves, that " the hydrophobia is only a D " violent • Salius diverfus de venenis, p. 349.—Van Sw',eic;i comment. spli. 1138. f Whytt's works, p. 680, 4to. Ci violent convulfion of the gullet and ftomach, ari- " fing from the difagreeable fenfation excited by " the liquid touching the fauces." But neither of thefe explanations is fatisfactory: the former does not inform us of the ultimate caufe of the fick being rendered worfe by fwallowing liquids ; and the latter, by the above quotation, and in other parts of his work, refolves it into the fpecific stimulus of water on the throat. The explanation, therefore, that Iwould propofe of this fymptom is as follows. In confequence of the action of thepoifon, on the nerves of the body as be- fore mentioned, a morbid and exceffive degree of fenfibility is induced ; whereby the action of the flighteft stimuli produce the moft difagreeable ef- fects. The fauces alfo, particularly the mufcles employed in deglutition, partake of this general morbid state; as foon therefore, as any liquid touches them, they are feized writh fpafmodic af- fections which confequently excite pain ; in the ve- ry irritable state of the parts, this pain becomes ex- treme ; on a fecond attempt, therefore, to drink, or a mere mention being made of it, the idea of the patient's former fufferings will be immediately excited, and confequently he will refufe it with difguft. But r 27 ] But even this pain may be excited by the irritation of the faliva, on the very irritable fauces; whereby an attempt will be made to fwallow it, and this gives the firft idea ofdifguftto fluids, before any exertion has been made to drink. Accordingly the patient will endeavour to avoid a repetition of an act which excited fo much pain; and any liquor will be refufed afterwards, or the mere fight of the water, renewing the idea of his pain, will produce the fame effect. This explains the caufe of the terror fhewn by fome perfons in the firft ftage of this difeafe, before any attempt has been made to drink ; and which has feemed to eftablifti the com- mon idea that the averfion from fluids was not ow- ing to a difficulty of fwallowing, but to a fpecific dread of them. Thus Sauvage f relates the cafe of a butler, who was unable to fupport the fight or touch of water, though he had not as yet made any attempt to drink : and Mr Babbington % alfo mentions, that the boy, whofe hiftory he defcribes, D 2 fhewed * " To afk one in this condition to drink, is to defire to choak himfelf; and when he has found this to be io, he dreads the fight of liquors offered to him, as much as he would a knife prefented to his throat, and ftrives to keep them from his mouth." Mead's Works, p. 83. f Sauvage fur la rage, p. 12. Van Swieten, Com. Apher. 1138.' % Med. Com. Vol. I.p. 214. r 28 ] " fhewed evident agitation at the fight of a cup of " mint water poured out for him to drink." But the difeafe had at this time fubfifted for feveral hours; and therefore his age, and probably his constitution, favoured the increafe of that morbid fenfibility which it is the nature of the poifon to induce ©n the fyftem. The affection of the throat, then,contrary to the opinion of VanSwieten andDr. Heyfham, precedes the averfion fhewn from drink- ing; for the former are very frequently with the ftd- mach the firft parts attacked, as mentioned before, and occurred in a remarkable manner, in the cafes re- lated by Drs. Lifter *, Wilbrahamf, Vaughan+, and Mead§; in thefe therefore the averfion from liquids appeared as a primary fymptom; but in other cafes, where from a variety of circumftances this affection of the throat or ftomach did not come on for fome- time, water, and other fluids, were taken with the greatejl eaje and compojure, until the commence- ment of the affection of thofe parts, foon made them difgufted at the fight of it. Thus Dr. Lif- ter remarks, that it was not until the fourth day after * Philofoph. Tranf. Vol. HI. p. 276. t ibid. Vol. XLVII. p. 413. % Vaughan's Cafes, p. 4. $ Mead's Works, p. 660. [ *9 J after his patient firft complained, that any averfion from drinking appeared ; for, on the day prece- ding, " he called for burnt brandy and drank it." And it was not until the next day, when he perceiv- ed a ftrong rifing in his ftomach, that he had " an impotence to drink." Dr. Howman alfo fays, that no averfion from water, took place until thefeventh day of the attack, and that preceding the death of the perfon, when the fpafmodic affections became fevere. Mr. Bathie's f patient fliewed no difguft to fluids, until the difficulty in fwallowing came on; and he remarks, that when this occurred, " and the fluid touched the fauces, it feemed at the " peril of his life." Dr. Vaughan J, in the hiftory of . -his fecond patient, mentions, that he was attacked fl on Tuefday, yet he drank all that and the fucceed- ing day, until the evening, and next morning ; 3Jwhen the occurrence of a vomiting evidently _3{hewed an affection of the ftomach. In the cafe Dl related by Dr. Gray §, it was not until the fifth - day, that any averfion from fluids was fliewn. Mor- gagni || remarks alfo, that there are fome who will drink water itfelf without difficulty, when the firft f Edinb. Med. Com. Vol. III. p. 290. J Vaughan's Cafes, p. 22. ^ Med. Comment. Vol. XI.p. 304. B Letter 8th, Art. 30. C 3" ^ firft trouble of fwallowing is overcome; and quotes two cafes from the Ephemerides of the curious, in proof of the affertion : and fo fully convinced was Dr. Mead of the averfion from fluids, depending on a difficulty of fwallowing, that he faid the name of the difeafe ought to be changed—and that inftead of " hydrophobia," it fhould be called " Duf- katapofis*." But further, although thefe cafes render it probable, that the dread of water, as it is called, fucceeds, or at leaft appears at the fame time, with the affection of the throat, yet that the former depends entirely upon the latter, is fully proved by this fact, viz. that in thofe perfons where the throat was entirely free from any affection during the whole courfe of the difeafe, or where the violence of the fymptoms had abated, water and other fluids were taken with the greatest compofure. " A learned physician," fays Dr. Mead, " has affured me, that in Shropfhire he " faw three patients in one year, yet none of them " during the melancholy fcene, had any difficulty " of fwallowing, or fhewed any figns of a dread " of liquids." Dr. Houlfton has alfo in the Lon- don Medical Journalf, publiflied a letter from a phy- fician, where it is mentioned, that during an inter- val of fixteen hours, which took place in this dif- eafe, * A difficulty in fwallowing. Meads' Works, p. 84. f Vol. V. No. 4. for 1784. [ 31 ] cafe, liquids of all kinds were fwallowed freely. The third perfon, whofe cafe is related by Dr. Dick- fon *, alfo drank feveral cups of tea in the latter end of the difeafe. The public papers f laft year, gave us an account of a fervant in one of the pub- lic inn's near London, who died of this difeafe ; and who, " to the aftonifliment of the attending medical faculty," drank in the progrefs of his complaint, freely and without the leaft difcompofure, great quantities of liquids. If, therefore, the averfion from drinking, moft commonly fhewn by thofe perfons who labour under the effects of the canine poifon, were owing to the poifon fimply, and fome fpecific change wrought on the fyftem, the abfence of the affection of the throat, entirely in fome cafes, and its abate- ment in others, ought not to make the leaft altera- tion in this generallyfuppofedpathognomonic fymp- tom; for the poifon being ftill in the fyftem, its ef- fects fhould invariably and constantly continue. But the direct contrary is obferved to take place. How then can this fpecific dread be accounted an univerfal caufe ? But * Med. Obf. and Inq. Vol. III. p. 368. f London Paper; Times Novemb. 30, 1790. Dunlap'i Ame- rican Advc/tiicr, January 1791. r v i But further, another proof of the truth of the explanation I here have given refpecting the aver- fion fliewn from fluids by perfons labouring under the effects of this difeafe, is derived from the decla- ration of the patients themfelves, who, as was faid before, are moft commonly poffeffed of their fenfes, and are capable of returning rational col- lected anfwers to queftions propofed to them. Thefe conftantly refer the whole caufe of their difguft to fluids, to the difficulty in fwallowing. Thus, in the cafe related by Dr. Hartley*, it is remarked, on being alked, " whether his " averfion from drinking proceed from any pain in " Jwallowing, or Jomething elf? ?" he replied, " to " a pain in fwallowing." Mr. Nourfe's f boy be- ing ailved, why he had not taken any nourifhment as defired, gave as a reafon, that " he could not fwallow." In the firft cafe related by Dr. Mead+", the patient declared twice on attempting to drink, that it hurt him to fwallow, and threw the fluid out with violence. Morgagni || likewife takes notice that thefick, "when alked why they didnotdrink?" have anfwered, that they could not by reafon of the great con- * Philofoph. Tranf. abr. by Martin, Vol. XI. p. 225. f Ibid. No. 445. X Mead's Works, p: 659, || Morgagni Letter, viii, art: 19, [ 33 3 conltriction and narrowness of their fauces, or gula, as Salius, teftifies, and Aromatarius con- firms. In another cafe *, the perfon exprefsly declar- ed, " he could not fwallow for fomething in his " throat, that interrupted thepaffage;" and made exertions to fupprefs a vomiting, with which he was repeatedly threatened, for fear of increasing the obftruction in his throat. So far from being afraid of drinking water, the fick lament with the greateft anxiety, their inabi- lity to relieve the thirft which afflicts them, and by various contrivances, endeavour eagerly to drinkf. Mr. Bellamy J expreffed no fear of water, but only complained of the difficulty of fwallow- ing ; others again express a defire to go into the bath]| ." Tsie confideration, however, that the fame averfion from drinking, happens in other nervous difeafes, where the fame fpafmodic affection of the the mufcles of deglutition and the lame morbid E fenfibility » Edinb. Med. Com. Vol. III. p. 290. f Philofoph. Tranf. abr. Vol III. p. 277. J Fothergill's Works, p. 353. f| Vaughan's Cafes and obf. p. 34. L 34 1 fenfibility occur, will alfo tend to prove the caufe here affigned, and the total inutility of having any recourfe to the poifon, in order to account for this Angular fymptom. It was mentioned, before that Dr. Mead * obferved it in hyfteria, Drs. Per- cival f, and Rufh {, have recorded cafes of its oc- curing in Tetanus. But it may be afked, if there be no fpecific dread of fluids, why are folids fwallowed with lefs diffi- culty than liquids, contrary to what is obferved of all other affections of the throat ? To this I would reply, that a very material difference exists between an affection of the mufcles of deglutition, proceed- ing from a ftate of inflammation, and a diftenfion of the part, and that affection proceeding from the difeafe at prefent under confideration. In the former, liquids are fwallowed with greater eafe, as requiring lefs exertion of the mufcles than folids, which create great pain by increasing the preter- natural diftenfion already existing. In the latter, liquids are fwallowed with greater difficulty for the fame reafon, viz. requiring more exertion of the mufcles, of which the patient has entirely loft the commmand ; but folids are enabled to defcend with greater * Meads Works, p. 83, f EffaysMed. Philofoph and Exp. Vol. II. p. 366. t Med. Inq. and Obf. p 178. I 35 1 greater eafc, as by their bulk they do not require fuch a forcible contraction of the mufcles in order to force them down. It muft be alfo recollected,that in performing the act of fwallowing, the tongue is drawn backwards, and at the fame time preffed against the upper and back part of the palate, ex< tended over the roof of the mouth, whereby the fubftance is preffed against the epiglottis, which by its own elasticity is constantly at other times erect, and thereby effectually and completely covers the windpipe, directing the paffage of the food im- mediately into its proper place or gullet; the extension and continuation of the foft palate at the fame time preventing its regurgitation up through the nofe. When, therefore, thefe parts are af- fected with a morbid fenfibility, and the healthy action is taken away, as in the prefent difeafe, a fluid is no fooner applied to them, than a fpafmodic affection is excited in the part, and they not being able to overcome this, it terminates in a violent convulfion: butjolids, by their diftenfion, overcome the stricture and refiftance made to their progrefs by the convulfion of the parts, and thus they de- fcend into the cefophagus with greater eafe : they are alfo enabled to prefs down the epiglottis, which liquids, by their want of this distending power, are rendered incapable of doing. Fluids likewife, as Dr. Seleg obferves, " penetrate the fides of the E 2 mouth, C 36 3 " mouth, the tongue, and the throat much more, " and produce therewith a greater irritation or " commotion than the folid food can have upon " thefe parts *," in confequence of a greater fur- face, which is endowed with this morbid fenfi- bility, being expofed to the ftimulus of the fluid. In a ftate of health, when the mufcles of the throat can be commanded at pleafure, and the nerves which supply them are not affected with a morbid fenfibility, the action of deglutition is fuf- ficient to prefs down the epiglottis, assisted by the flight gravitating influence of the fluid itfelf ; but in the prefent difeafe, this healthy action of the parts being deftroyed, there remains nothing but the mere mechanical force of the fluid to effect what was done by the united force of both before, which being unable to accomplifh,a violent irritation in the part enfues, with great pain, and an immediate rejection of the liquids. This explanation is greatly strengthened by the confideration of this circumftance, that in other difeafes where there is the fame want of command of the mufcles of deglutition, folids are fwallowed with greater eafe than liquids; but from the fame morbid fenfibility of the parts not accompany- ing the difeafe, the latter do not excite fo much pain, as in the difeafe confequent on the bite of a mad * Med, Mufeum, vol. ii. p. 228. C 37 ] mad animal. Thus Van Swieten * relates that he attended a woman, who, as he fays, had " a palfy " of the mufcles of deglutition, in whom the " fwallowing continued to be hindered in fuch a " manner, that flie could not get liquids down at " all, but was only able to fwallow large mouthfuls " of folid food." The fame is further confirmed by this, that patients in this difeafe can frequently fwallow liquids, but only when taken in large quan- tities at a time, or in fucceflive draughts f, as by their bulk they prove fuperior to the fpafmodic constriction which takes place from the irritation created by them. And although Sauvage's J pati- ent could not fwallow water, yet he could broth, which proved much lefs difagreeable to him, as it approached nearer to the nature of a folid, and confequently would act more by gravity in preffing down the epiglottis, and overcome the ftricture raifed by the irritation on the fauces. If this averfion from fluids depended on a power of irritation poffeffed by all kinds of liquids, as af- ferted by Dr. Heyfliam, then folids fliould never be refufed, but fwallowed with as much eafe as in health. The contrary, however, is the cafe ; and I apprehend one great reafon, why the notion has * Comment. onBoerh. aph. 818. f Memoirs Lond. Med. Soc. vol. i. p. 249. % Sauvage, dilfcrtat. fur larage. p. 12.—Van Sweiten aph. iijS [ 3» 1 has fo universally prevailed, of a fpecific dread of fluids being peculiar to the difeafe, is this: From the circumftance of the thirft, that diftreffes the patient, he is induced to afk for drink, which he finds it difficult and painful to fwallow. Hun- ger, although it fometimes takes place, is by no means fo uniform a concomitant of the difeafe as thirft, and it has feldom occurred to try whether the fame difficulty prevailed equally with regard to both folids and fluids. In the few cafes, however, where the experiment has been made, the fame difficulty was experienced in fwallowing both the former and the latter, and the convulfions have been equally excited by a mere fight of either. Dr. Lifter * relates, that his patient found great difficulty in fwallowing food. The boy, whofe cafe is recorded by Dr. Dickfon f, declined eating fome meat that was offered him, and when preffed) he begged that it might be cut fmall, in order that he might have as little trouble as poffible. Dr. Johnston J fays, that any attempt to fwallow fome bread, occafioned the greatest agonies. Dr. Gray likewife takes notice, that after the difeafe had fubfifted fome days, his patient equally abhor- red * Philof. Tranf. vol.iii, p. 277. f Lond. Med. Obf. and Inq. vol. iii, p. 364. t Memoirs Med. Soc. Lond. vol. i, p. 260. r 39 J red folids as well as fluids, and when importuned to eat, he was thrown into convulfions*. Not- withftanding Mr. Babbington f mentions the dread the boy, whofe hiftory he records, had of fluids, he takes no notice of the leaft difficulty in fwallowing folids: but our profeffor, Dr. Grif- fits, informed me, that he attended the hofpital at the time the boy was there, and that the aver- fion from fwallowing equally refpected folids as well as fluids, and refufcd either to drink or eat ; giv- ing as a reafon, that " it tore his ftomach." In the cafe recorded by Mr. Bathie, the patient ob- jected to eating fome food, faying, " its paffage at " the throat would be interrupted as had hitherto " been the cafe with drink." After this difcuffion of the apparently fimple queftion, refpecting the caufe of the averfion from fluids, I expect no doubt will remain, as to the propriety of referring it to the affection of the throat. 1 have fliewn, that in thofe cafes where this did not occur, fluids were fwallowed with the fame eafe as in health, and alfo explained the reafon why for the moft part folids excite lefs pain. From the actual declaration of the patients themfelves, it was likewife rendered clear, that there was no fpecific dread * Edin. Med. Comment, vol. xl, p. 304. f Med. Commuu. vot i. p. aij. C 40 1 dread of fluids, but that the fole caufe of the hor- ror expreffed at the fight of them, originated from their renewing the idea of their former pain. But laftly, the fame averfion to fluids happening in other difeafes where a fimilar fpafmodic affection of the mufcles of the throat, and a fimilar exceffive fenfi- bility takes place, prove the falfity of the opinion, which fuppofes the averfion to depend on' the poifon. There are feveral other fymptoms of this dif- eafe which merit an explanation : but were I to attempt thefe, it would extend this differtation be- yond all bounds, and I muft therefore decline their confideration, and proceed to the DEFINITION. I deferred this part of my fubject until this place, becaufe there were feveral circumstances required to be explained, before the definition could be given, and which tended to contradict the opinions of authors on which the definition of the difeafe was founded. Dr. Cullen defines the difeafe to confift in " a " difguft and dread of any fluid to be drunk, as " exciting a painful convulfion of the pharynx or " gullet, for the moft part from the bite of a mad " ani- [ 4i 1 "animal*." By this definition, the illuftrious profeffor has constituted the averfion from fluids an effential fymptom of the difeafe, and has fuppofed it to precede the affection of the throat: but I have fliewn, that it is not a constant fymptom of the difeafe, and that folids as well as fluids frequently are equally difficult to fwallow. It has been alfo rendered clear, that this averfion from fwal- lowing, depends entirely upon the recollection of the difficulty and pain experienced in a former at- tempt. Dr. Cullen likewife fuppofes the difeafe to arife fpontaneoufly in fome cafes, which I have before rendered probable, never happens* I would, therefore, fay, that the difeafe of which we are treating, confuted in " violent convulfions of the " whole body, particularly the throat, creating a " difficulty of fwallowing, proceeding from the " bite of a mad animal." The length of time that elapfes between the in- fliction of the poifon, and the appearance of the difeafe, is very various ; I am by no means, howe- F ever, * Potionis cujuflibet, utpote convulfionem pharyngis dolentem mentis, fuftidium et horror. Cul. nofol. method, genus biv. I 4* 1 ever, difpofed to give credit to stories related by various authors of years elapfing before the perfon became affected. Thus Morgagni # refers to the Ephem. naturae Curios, for a cafe where twen- . ty years intervened between the bite and the ap- pearance of of the difeafe ; and alfo to another au- thor, who fays forty years elapfed ; but I think thefe authorities mayjuftly befufpected. And even Van Swieten, who, on other occafions, appears to have been fufficiently ready, to give credit to things related on flight authority, entirely re- jects the above ; and very properly mentions the neceffity of avoiding to inculcate fuch stories, on account of the bad effect it might have on the minds of weak people f. But whatever doubt may be entertained of the credibility ©f the cafe referred to by Morgagni, " there can be none," fays Dr. Percival, " of the cafe which the fame | *'• author j relates, of a boy under his own infpec- " tion, in whom the fymptoms came on five months " after abite§. "Dr.Vaughan|j has given us a cafe, where nine months elapfed between the bite and the commencement of the difeafe andinftances at nearly * Letter 8, Art. 21. t Comment, on Boerh. aph. 1137. X Letter 8, Art. 22. § Pcrcival'sEffays, Vol.11. p.37o. || Cafes and Obf. on Hyd. p. 22. [ 43 ] nearly fimilar diftances of time, are related by au- thors. Dr. Tilton has recorded a fuppofed cafe *, where nineteen years elapfed between the infliction of the bite and the attack of the difeafe. But I cannot think with that gentleman, that it proceeded from the poifon having remained fo long latent, without affecting the fyftem. It is faid that the wound would frequently break out, and difchargc freely. Now, we have no instance of the real difeafe, where the fame circumftance is mentioned ; even on the attack, although a pain is generally felt at the bitten part, yet it feldom happens that the wound breaks out afrefli. If this cafe, proceeded from the poifon, it certainly would have operated on the fyftem the firft time of the wound's breaking Out; which, moreover, was not the cafe in the prefent inftance. Another reafon for not fuppof. ing it to proceed from the poifon, is, that there is no inftance on record of a real cafe of the difeafe being cured, by the fame mode of treatment, viz, large and copious bleeding, and other debilitating means ; which though constantly recommended by writers on the difeafe, yet they have adduced no proof of the efficacy of the treatment. It is true, this woman had a moft violent dread of water; but this, as I have already proved, takes place in the hyfte- ria, which difeafe, in fact, I imagine the one de- fcribed by Dr. Tilton to be. In this difeafe the fame F 2 morbid * Med.Comment. Vol. VI. [ 44 3 morbid fenfibility of the nerves of the whole body, and particularly the fauces, prevails, into which I have endeavoured in fome meafnre to re- folve the averfion fromfluids. It is remarked alfo that this woman was of a very irritable habit, and fuch we know, are moft fubject to hysteria. A very vio- lent attack of this difeafe, frequently borders on mania, and requires very copious blood-let- ting for its cure; and fuch indeed does the cafe related by Dr. Tilton appear to have been. The only cafe to depended on of the greatest interval of time occurring, is that mentioned by Mr. Nourfe, where nineteen months inter- vened between the bite and the appearance of the difeafe. On the contrary, the fhorteft fpace re- / corded, is that related by Dr. Gray, to have hap- ' pened in the Eaft Indies, where death followed the evening of the fame day in which the bite was received. At different periods between thefe two last mentioned, the difeafe has frequently appeared; but the moft common time may be included be- tween three and fix weeks. Here it would be an ufeful inquiry, to inveftigatc the caufe of the variety, in the time of the appear- ance of the difeafe. This has been attempted by many authors; but, in my opinion, it has not as yet been accounted for in a satisfactory manner. The follow- ing C 45 ] ing are the principal caufes which have been afilgn- ed, as influencing the late or early attack. i. The part of the body bitten. 2. The ftage of the animals difeafe, at the time of inflicting the bite. 3. The difference of the original virulence of the poifon. 4. The quantity of it infested into the wound. To enter fully into a difcuflion of each of thefe affertions, although highly ufeful, would extend my differtation to too great a length ; I therefore fhall be as brief as poffible. 1. The part of the body bitten, is univerfally ad- mitted by authors, as having a very confiderable influence on the period of attack. From the erro- neous idea entertained of the fpecific tendency of the virus, to unite with the falivary fecretion, it was faid,that the nearer tothehead, the bite was receiv- ed the fooner would the difeafe appear. But for this opinion, there is not the leaft foundation. In repeat- ed inftances, where the bite has been received in the head and parts adjacent, and where confe- quently the poifon might be fuppofed to have a ve- ry ready communication with the faliva, the difeafe has not appeared fooner than in other cafes where the r 46 j the wound has been, received in the moft distant part of the body*. 2. The ftage of the animal's difeafe, at the time of inflicting the bite. From the virulence of the poifon, which has hi- therto been generally fuppofed proportional to the continuance of the difeafe in the animal, a bite re- ceived in the latter ftage, has been imagined to be much more dangerous than one inflicted when the dog was not long mad. But experience has fhewn, that a bite received in the firft ftage, has proved equally and as fuddenly fatal with one re- ceived after the difeafe had fubfifted fometimef. 3. The difference of the original activity of the virus is fupported on hypothefis alone. We have no proof of this difference ; and the idea is op- pofed by the analogy of other contagions particu- larly the fmall-poxj, and venereal, difeafe || in which it is well known the kind of matter has no influ- ence over the difeafe it produces. I * Med. Commun. Vol. I.p. 214. Morgagni Letter viii, Art. 29. Ibid. Letter viii, Art. 22. Med. Obf. and Inq. Vol. III. p. 359. Memoirs Lond. Med. Soc. parti, p. 255. f Hamilton's Remarks, p. 201. Med. Commun. Vol. I. p. 216. Med. Comment. Vol. XI. p. 304. X Cullen's Firft Lines, Vol. II. p. .140. I| Hunter's Treatifcon the Ven, Dif. Cb.'p. I. Sect. vi. r 47 j I fliould imagine likewife, that as the difeafe can- not be excited, unlefs the poifon has'arrived at a certain degree of perfect formation, fo, if this has taken place. I cannot fee the propriety in fuppofing any additional activity, as all it can effect is to ex- cite the difeafe. The proportional violence of the fymptoms, muft then depend on the difference of conftitution. 4. Tin: quantity of the poifon inferted in a wound, is equally void of influence reflecting the appear- ance of the difeafe. In many cafes, the bite has been fo trifling, asfearcely to be noticed, which has ( produced the difeafe as foon and certainly as where ' it has been very extenfive. It would be unnecef- fary to quote inftances, as they may be found in every author. Having, as I hope, fliewn the fallacy of the many caufes assigned by authors, for the compara- tive, early, or late ajtack of the difeafe in different perfons ; I fliall now proceed to lay down that which appears to me to be the true caufe of the variety. This, in my opinion, depends on the influence the greater or lefs fenfibility of the fyftem, as de- pending on 1. Original Confirmation ; and, 2. Climate. When I 4§ J I. When fpeaking of the action of the poifon itf the production of the difeafe, I fliall fhew that it firft acts for the moft part, on the nerves of the place where it was inferted, and afterwards brings thofe of the whole fyftem into fympathy. The influ- ' ence of the greater or lefs fenfibility of the nervous fyftem will, therefore, be readily perceived to be confiderable, in favouring,or retarding, the appear- ance of the difeafe, inafmuch as it favours the in- creafe of that morbid ftate, which I have already mentioned to be the peculiar property of the poi- fon to induce. This has been found to be the cafe in the prefent inftance ; for thofe per- fons, who either by habit, or other circumftances, were of an irritable nature, have been obferved to be attacked much fooner than in thofe who poffeff- ed lefs fenfibility of the nerves. Thus, in women and children, who, for the moft part, have their nervous fyItems very eafily moved, a much fhorter period has interved between the bite, and the commencement of the fymptoms, than in men, who from poffefling lefs delicacy or fenfibility of their nerves, have remained longer free from the difeafe. Thus, Sauvage * relates the cafe of a woman, in whom the difeafe came on in three days after the reception of the bite. In a boyf, a period * Sauvage, fur la rage, p. 4. t Med. Commun. vol. i, p. 214 C 49 ] period of only feven days elapfed between the bite and the appearance of the fymptoms: while a " laborious farmer *," who was bitten in Septem- ber, felt no inconvenience until the June fol- lowing. This reafoning is confirmed by what we fee re- fpedting other nervous difeafes, where a greater or lefs degree of fenfibility, has a moft important influ- ence in their production, by rendering the fyllc:n more liable to the imprefiion of ftimuli. Thus a fudden fright, will throw fome women into convul- fions, while others will be not in the leaft affected by it, except a flight momentary agitation. The noife of a perfon chipping bricks f, or the found of a bell t, have occafioned fainting and convulfions. The Turks, from the immoderate ufe of opium, are affected with the greateft fenfibility of fyftem; and to fuch a degree does it prevail, that the flighteft noife, fuch as the fudden fliutting of a door, the falling of a fonorous body on the floor, will occafion involuntary ftartings and tremors, fimilar to what we obferve in women who are highly hyfterical ||. On the contrary, G when • Vaughan's cafes, p. 22. f Kirkland's enquiry prefent ftate med. lurg. vol. i, p. i99- X Boyle's ufct. of experiment, phitafoph. part, ii, p. z+3. || This fait I deliver on the refpeftable authority of Alexander Pol's, M. D. of this city, who, from feveral years icui'enceat Con- ftantinoplc, had frequent opportunities of witndlvig the flut. r 50 j " when either the whole nerves, or a part of " them, are deprived of a proper degree of ii fenfibility, the body in general will then be lefs " apt to be affected by the above caufes; and the " action of thofe parts will be imperfect. Thus, " when the nerves of the intestines are lefs difpofed " than ufual to be affected by their natural Jlimuli, " the irritation of the aliments, air, and bile, will be " be only able to raife a languid periftalic motion, " and therefore the perfon will be coftive : when " the fenfibility of the retina is impaired, objects " are feen lefs diftindtly *." 2. The fecond caufe mentioned as favouring this early appearance of the difeafe, by producing a greater fenfibility of body ; was the Influence of Climate. The effects of exceffive heat, in producing a great degree of fenfibility of body ; and on the contra- ry, the tendency of cold, to diminifli it, are well known. Hence in warm countries the greater frequency of nervous difeafes, particularly Tetanus, which is. accounted endemial to hot climates and feafons. In this city alfo, during the warm wea- ther, it frequently appears : but the obfervation of physicians refpe&ing the prefent difeafe, puts it Whytt's works, 4to. p. 527. f 51 ] it beyond a doubt, that in warm climates, the difeafe comes on much fooner after the infliction of the bite than in thofe that are cold. In the Eaft Indies, it is faid to be in particular very rapid in its progrefs, and Dr. Gray * relates, on the au- thority of Mr. Murray, formerly an officer in the Nabob of Arcot's fervice, that when at Madrafs, he faw a boy brought into the fort, who died in the evening of a bite he received the fame day. SYMPTOMS IN DOGS. In order to difpel any fears, in cafe a bite fliould be received by a dog, fuppofed to be mad, or to ftimulate others to apply for early relief, it may be neceffary to briefly to mention the fymp- toms whereby a dog may be known to be affected. Thefe, after the difeafe has fubfifted for fome time, muft be evident to any one, but in its very com- mencement, it is an important confideration to be able to afcertain the fact in a clear and decid- ed manner ; as I have fhewn that the poifon, though contrary to the univerfal opinion of all writers, is equally capable of producing its fatal effects in the firft attack of the difeafe, as in its lat- ter ftage.— 1. A Loathing of food, which is generally ac- counted by authors as a certain fign of the difeafe, is • Med. Commen. vol. xi. p. 304. l 5* : is by no means worthy of being trusted to, as dogi in the firft ftage after heartily eating, have given a bite, which has caiifed the difeafe. In the cafe of Admiral Rowley'sfon* " the animal turned fromits " meat, and bit him on the right fide of the lower " lip."—Mr. Bathie alfo tells us, that the dog, «' far from exhibiting any appearance of madnefs, " deceived the boy by fawning on him, and without " reluctance eat bread which he threw down to "himf." Both thefe perfons, however, were af- " terwards affected and fell victims to the difeafe." 2. An averfion to water, though likewife ufu- ally mentioned as a fymptom of the difeafe in thefe animals, does not always appear. Mr. Andrew EllicotJ, informed me, that he faw a dog in the height of the difeafe, fwim acrofs the river Petap- fco near Baltimore. Dr. Hamilton likewife men- tions two inftances where dogs lapped water but a few hours before they died§. The only fymptoms in the cafe of Mr. Row- ley's dog, as related by Dr. Hamilton, was, that he looked poor and thin ; this, however, in my opinion, is not fo certain a fign as thofe which oc- curred * Hamilton's Remarks, p. 202. t Med.Comment. Vol. III. p. 290. X Geographer General to the United States, ^Hamilton, p. 262. £ 53 1 curred in the dog that bit Mr. Bathie's boy, viz. a dulnefs, and inflammation of his eyes, and being avoided by the dogs that came near*. This in- ftinctive principle of felf-prefervation, wifely im- planted in thofe animals, is fufficient to diftinguifh the actual prefence of the difeafe, although it may not appear by any fymptom whatever. In cafe, however, as it very frequently happens, that the dog which gave the bite is killed, and the unfortunate perfon willies toknow whether he was actually mad, we have an experiment related by Mr. Petitf, whereby our doubts may be fully af- certained. If a piece of meat be rubbed round the teeth and gums of a dog, that has been killed, and fuppofed to be infected, and given to another dog, he will eat it if the dog was free from infec- tion, but reject it, if the difeafe exifted in him. From the known fact of all dogs flying from an infected animal, I am difpofed to think that Mr. Petit's obfervation is well founded, and therefore in fuch a cafe of doubt, it certainly deferves a fair trial. Too * This obfervation generally attributed to Dr. James, was men- tioned by Palmarius, de morfu canis rabidi, lib. cap. i. fAcad. de Sciences, 1723. p. 39- r 54 ] Too much, however, cannot be faid againft the practice of killing every dog fuppofed to be mad: Van Swieten* indeed strongly advifes it, and common opinion appears fully to concur with him. But I agree with Dr. Hamilton f in reprobating a practice, by which the truth can never be afcer- tained, while the perfon may be daily under the apprehenfion of an impending terrible difeafe. On the contrary, the dog fuppofed to be mad, fliould not be fuffered to be at large, but immediately confined. This caution is more abfolutely necef- fary, if a bite has been received, as a patient will thereby be enabled to judge from the termination of the dog's difeafe, whether he labours under any rifle, and the propriety of undergoing a trouble- fome treatment. REMOTE * Van Swieten Comment. Aph 1135 f Hamilton's Remarks, p. 153. [ 55 J REMOTE CAUSES IN DOGS. THE Remote Caufes generally laid down by authors, as producing a predifpofition to this in dogs, and other brute animals, are, I. Great Heat, or Cold. II. Putrid Aliment. III. Deficiency oj Water. IV. Want oj Perspiration. V. Worm under the Tongue. i. Of all the Remote Caufes enumerated, to none has more influence been attributed than heat ,- hence the difeafe is generally faid to be moft preva- lent in warm countries : and Dr. Hilary fays," It is " fo frequently feen in the moft hot countries, ." and efpecially in the Weft-Indies, that it may " be faid to be endemial*." Dr. Mofely, how- ever, in oppofition to this afferts, that it is " So " far from being true, that if Hillary, who treats " of it, and relates feveral cafes that were under " care, had not been a man of good charac- " ter, I fliould have doubted whether he had ever " feen a mad dog in the Weft-Indies. During " my refidence there, I never heard of the dif- " eafe ; and from the inquiries I have made, I am " certain • Difeafes of Rarbadoes, p. 245. [ 56 J " certain that there has been no canine madnefs " in many of the iflands for fifty years before the " year 1783*." In other countries equally warm with the Weft Indies, the difeafe has never been known. In South-America, DonUlloa fays, " The " people there exprefs their aftonifliment when on " European relates the melancholly effects of it.f" The fame fact is given on another authority|, and noticed by Van Swieten ||. Mr. Defportes § alfo, who practifed phyfic in Hifpaniola, from 1732 to 1748, relates that the difeafe was a stranger there during that period. Mr. Volney^[ likewife informs us, that in Egypt and Syria, canine mad- nefs is unknown, and that Profper Alpinus has alfo made the fame remark in his treatife on the phyfic of the Egyptians. Although the facts here ftated may feem, at firft view, to militate againft the common idea of the influence of heat in the production of the difeafe; yet I apprehend that the circum- ftance * Difeafes of Tropical Climates, p. 32. f LHloa's Voyage, vol. I. p. 296- X Biblioth. raifone, 1750, Avril, May, Juin, p. 422. || Van Swieten's Commentat. on Boerh. Aphor. 1129. ^Hiftoire de Malad. de St. Domingue. Mofely, p. 32. fl Travels, vol. I. p. 149.---Dub. 1791. [ 57 J ftance of its not prevailing in the above places, may be fully explained, and will be found not in the leaft to detract from the general influence of the caufe. To account, therefore, for the exemp- tion of thofe countries abovementioned from the difeafe, I fhould imagine that there was, and may be, fome local caufe operating, tending to prevent the appearance of it, by counter- acting the effects of the heat. Thus, though Defportes did not fee it, yet it broke out in the Spring of 1783 in Hifpaniola, and in the month of June in Jamaica, where it raged until March, 1784. In other countries, alfo, the dif- eafe does not always prevail, although the heat of the weather be extreme, while at other times, under the fame circumstances, it is univerfal. Thus although dogs do not go mad at prefent in Syria and Egypt; yet Mr. Volney tells us further, that the " name of the malady is to be found in the " Arabic language, and is not borrowed from any " foreign tongue," which plainly fhews hat it was once known there. Dr. Mofely likewife informs us, that during the late war, in the Weft-Indies, " many dogs were feized with the difeafe, " which had no communication with each other ; " and fome dogs that were brought from Europe " andNorth-America, and that were not on fhore H and r 58 j " went mad on their arrival in the harbours of the " iflands*." I am therefore difpofed to embrace Dr. Mofely's idea of the caufe of the exemp- tion of the above places, and with him think it is owing to fome influence of the air. But as I mentioned cold as a remote caufe, this may alfo appear to oppofe the opinion of the ef- fects of heat, in producing the difeafe. It is ac- tually admitted for this purpofe by Dr. Heyfliamf. This, however, only proves that the fame end can be produced by two oppofite caufes. Heat and cold, when applied in in a moderate degree, produce the moft different effects; but are attend- ed with the production of the fame general debi- lity when applied in a violent manner. This ftate I am difpofed to believe, has a confiderable jfliare in exciting the difeafe in dogs, as I fhall hereafter fliew it has in men. The influence of exceffive cold or heat as equally favouring the production of the difeafe was known at a very early period of time, iEtius informs us, that it was common in thofe countries where the vio- lenceof Winter and Summer, was equally ex- ceffivet. During feveral hard Winters within my * Mofely Dif. of Trop. Climates, p. 33. T Diflert. de Rabie, cap. vi. X ./Etius, lib. vi. cap. 24. Van Swieten Aph. 1134. [ 59 j my remembrance in this city, dogs very com- monly went mad. This was particularly the cafe in that of the year 1779-80, when more of thofe animals perifhed by the difeafe than for a long time before. Throughout Maryland, I am in- formed on very good authority, it was ftill more. general. That dogs are capable of, and do actually labour under debility in the beginning of this com- plaint, is fully proved by their being affected with the fame fymptoms, which fo clearly characterifes the existence of that ftate in men ; as averfion from motion, love of folitude, down-caft look, tendency to sleeping, &c. Second. Putrid aliment is generally fuppofed to favour the production of the difeafe among brute animals, but this opinion is oppofed both by Drs. Parry and Heyfliam, on the principle of hounds not being more liable to the difeafe, who are fed on carrion, than other animals, # and becaufe fuch food is agreeable to them f. But, although I do not fuppofe, that a dog by feeding on fuch aliment alone, would become mad,yet I muft deny the posi- tion of thofe gentlemen, when they affert that fuch dogs are not more liable to the difeafe than others ; H2 * for • Parry diftert. inatig. de rabie contag. Edin. 177S— Weblteti prax. med. lyft. tom.ii. p. 261. f Heyftiamdiflert. inaug. de rabie can. Edin. 1777. chap vi. C $° ] for not only fuch aliment, but too high feeding al- fo, favours the production of it. We had a re- markable proof of the influence of carrion eaten by dogs, in fetting them mad fome years fince in in this city. At the conclusion of the late war, and before that period, all thehorfes and other animals that died in the city, were carried out to the commons, and suffered to putnfy there ; and it is well known, that at this period, madnefs was a moft common difeafe among the dogs, who ufed constantly to devour thofe carrion; but of late it more rarely occurs among them, fince the former practice is not any longer fuffered. Third. A deficiency oj water, has alfo been uni- verfally accounted one of the moft common caufes of this difeafe. Hence it has been faid to prevail moft in dry feafons, and countries; and fo powerful- ly does the idea of its influence operate, that in fome countries, it attracted the attention of govern- ment, and meafures are accordingly taken to pre- vent the difeafe,by having the animals duly fupplied with that article *. But there are fome circum- itanees * Dr. Mofely informs that in Venice they fuppofe it is often brought on by thirft; for which reafon, barbers, fhoemakers, &c. Tiave a fmall tub of water always before their doors, that the dogi running about the ftreets may drink when they want, as there are no places in that city where they can otherwife fupply themfelves with frefti water. Difeafes of Tropical Climates, p. 33. I 61 ] fiances to prove that there is but little connection between the production of the difeafe and.the de- ficiency of water. For in the ifland of Antigua, where there are no fprings, but all the water ufed is brought from the neighbouring iflands,or caught when the rain falls, Dr. Parry # afferts, on the au- thority of Dr. Samuel Athill of the above place, the difeafe is unknown. Fourth. A want of perfpiration, has likewife been one of the caufes to which the moft powerful influence has been attributed in the appearance of the difeafe among dogs, and other animals: " The " rabies or madnefs," fays Dr. Mead," in a dog, " is the effect of a violent fever: no dog ever fweats, | " from whence it follows, that when his blood is " in a ferment, it cannot, as in other creatures, " difcharge itfcif upon the furface of the body ; " and muft, therefore, of neceffity, throw out a " great many faline and active particles upon thofe ■" parts where there is the moft conftant and eafy " fecretion ; and fuch, next to the miliary in the " fkin in us, are the falival glands f." I will * Differtat. inaug. Edin. 177S.—Webfteri prax. med. fyft. vol. ii, p- 261. f Mead1* works, p. So. (_ 62 J I fliall not ftop to refute the erroneous opinions contained in this paragraph, as their fallacy will be readily feen, by any one acquainted with the improved ftate of physiology, at the prefent day, but will only obferve, that the affertion of there being no perfpiration in dogs is a mere hypothesis. The peculiar structure of their fkin, together with the circumftance of its being covered with dirt, or duft, prevents the appearance of actual fweat; yet that do they perfpire, and in a copious manner, is fully proved by the strong fmell, that every one perceives on approaching them ; and " by one of " thofe animals being able to trace another by the " feent of his footsteps, which could not happen if " a large quantity of perfpirable matter was not " constantly going off*." I would alfo remark, that the falivary difcharge, is the moft unfit fecretion, to furnifh an outlet to fluids requiring to be evacuated. In man, the dif- charge which is vicarious to that of the fkin, is by the kidneys, or bowels: hence the old adage, " Cutis laxitas eft alvi denfitas;" and it accordingly happens, that on the obftruction of the perfpiration, either a diarrhoea follows, or copious difcharge of urine, and vice verfa, thofe who have a free flow of perfpiration, * Note to Monro's comparative anatomy, in the new fyftem, vol. iii, p. 347. [ «3 J perfpiration, have the fecretion of urine diminiilied, and are habitually costive * ;" but this is not ob- ferved in dogs. What reafon, therefore, can be given for this variation in the performance of the fame function in different animals ? Do not fimilar laws govern the ceconomy of all animated nature, under fimilar circumstances ? Fifth. The laft caufe mentioned of this difeafe, was a worm under the tongue. Pliny f was the firft author who took notice of this. Various ' fubfequent writers, and even at the prefent time, when ignorance and superstition are nearly baniflied from the feience of medicine, and given way to truth and reafon, there are not wanting fome " who " have paid it implicit obedience, and given to it a " ftupid belief:];." The idea of a worm is utterly falfe, * The frequent inclination to, and difcharge of urine in dogs, may alfo feem to favour the idea of the defecl of perfpiration in tbofe ani- mals, by which a greater flow is determined to the kidneys: but I hope I have fully proved that this pofition is groundlefs, and the caufe of this frequent expulfion of urine is owing to the greater acri- mony of the fecretion, and more mufcular make, and lefs capacity of their bladders, by which they are unable to retain the urine fecreted, fo long as other animals, whofe bladders are of a more membraneous ftructure, and of greater dimenfions. .. f There is a worm in the tongue of dogs, fays he, which is called bv the Greeks Lytta ; and this being taken out, when they are young whelps, they neither become mad, nor feel any ficknefs or loathing. Nat. Hift. lib. 29, cap. v. X Hamilton's remaks p. 135. L <$4 ] falfe, as no fuch thing exifts. Dr. Brodie * fays he never could difcover, on diffection, any worm : ..yet Dr. Heyfham f, who furnifhes me with this authority, admits the idea of this fubftancc being a caufe of the difeafe, and approves of the vulgar practice of extirpating it. Others, who deny the exiftence of this fuppofed worm, affert that is a gland, and fecretes the venom which produces the difeafe: but no fecretory duct has been feen, which being effential to the nature of a gland, this idea j muft then be equally futile ; neither is it a nerve, as I fuppofed by Dr. James, but a fpiral substance be- tween the nature of a ligament and tendon, as fhewn by that excellent anatomift Morgagni \. The nature of this fubftance being determined, let us examine into the actual merit of it, in the production of canine madnefs. In the firft place, Dr. James, who was one among the few oppofed to the doctrine, afferts, that not the leaft fecurity is afforded to any dog by the extirpation of this fubftance. The great ex- perience of this gentleman in the difeafes of the canine tribe is well known, being as Dr. Hamilton fays, * Differt. inaug. p. 8. -"■+ Differt. inaug. Edin. 1777, cap. vi. X Letter viii. art. 35. r 65 1 fays, " a profeffed dog doctor," and his opinion, therefore, merits the utmoft attention. " Dogs," fays he, " thus treated, run mad equally with " thofe who have never fuffered this abfurd opc- " ration*." Dr. Berkenhaut likewife treats it with ridicule, as having no foundation in truth f." But, Dr. Hamilton's teftimony would alone have been fufficient to difprove the notion. He has fully fliewn, from the teftimony of a perfon of credit, at Ipfwich, who has wormed many hun- dred doSs» tnat it afforded no fecurity. I REMOTE • Treatife on canine madnefs, p. 204. f EfTay on the bite of a mad dog, quoted by Hamilton. r 66 ] REMOTE CAUSE IN MAN. HAVING already in the preceding pages, en- deavoured to refute the common idea, of the fpon- taneous production of this difeafe in the human body ; the only remote caufe that I can allow, is a poifon of a peculiar nature in thejaliva of a rabid animal, belonging to the genus canis. A qucftion here arifes, which it is neceffary to determine. In what manner, or by what means, is the virus which produces this difeafe, communicated to the fyftem? Tsie idea of the peculiar fubtlety, and penetrating activity of this poifon, which has hitherto been generally entertained by phyficians, has occasioned them to fuppofe many ways by which it was ca- pable of entering the fyftem. Some of thefe ap- pear to be founded in imagination alone. There are other opinions, however, refpecting the mode of introduction of the virus, which deferve fome attention ; but which likewife appear to be erro- neous. Thefe fhall accordingly be noticed, and the action in the virus in the production of the difeafe finally pointed out. I shall confine my obfervations to the follow- ing [ 67 ] ing modes, by which it is faid, the poifon can be received into the fyftem. 1. By abforption. 2. By the breath drawn into the lungs. 3. By contact with the faliva. 1. That the virus enters the fyftem by ab- forption, and thus produces its fpecific effects, is an opinion, which has been entertained long before the difcovery of the lymphatics; and although, at firft view, this may feem a probable way of accounting for the production of the dif- eafe, yet I apprehend, on a more minute inveftiga- tion, the idea will be found totally void of foun- dation. If an actual abforption of the virus took place, we fliould uniformly find, that it would ftop at the firft lymphatic gland, which was fituated between the place of abforption and the common recepta- cle of the thoracic duct, and there caufe a fwelling and inflammation, fimilar to what is conftantly obferved to take place, in the abforption of the poi- fons producing the fmall pox, venereal difeafe ; or of pus of any kind. No fuch appearance, however, has ever been noticed by the writers of any of the 12 cafes r 68 ] cafes on record. Dr. Hamilton *, indeed, fpeak- ing of the pain felt in the courfe of the lymphatics, and in the axilla, or groin of the inoculated arm or leg, obferves, " the fame may be faid of the " venereal difeafe; and the fame remark has been " noted in the abforption of the poifon from rabid " animals." But in all the histories, which I have confulted, with a direct reference to this circum- ftance, I have never found it mentioned ; and in the many cafes which Dr. Hamilton has abridged from various authors, and fubjoined to his treatife, this affection is not taken notice of in any one of them. This, he certainly would not have omitted, had he met with it in a Angle cafe, inafmuch as it tended, in fo decifive a manner, to have confirmed his affertion reflecting the abforption of the poifon. A pain in the bitten part, as I have frequently mentioned, is for the moft part the firft fymptom of the general attack, but no pain in any of thelympha- tic glands is ever noticed. Nay, Mr. Babbington, exprefsly obferves, that the boy whofe cafe he re- lates " complained of a pain in his right arm, (the " bitten part) which was attentively examined, but " withoutanydifcoveryof inflammation,or enlarge- " ment of the glands of the axilla." Dr. Vaughanf likewife obferves, that " the progrefs of the virus, " towards * Hamilton's Remarks, p. 13. f Vaughan's Cafes and Obf. p. 4$. [ 69 J " towards an admission into the fyftem, can;. " not be difcovered by difeafed lymphatics, be- " tween the wound, and the next conglobate gland, " or what is more common in the gland itfelf." But, granting that the virus is abforbed and car- ried into the circulation, yet ftill a difficulty re- mains in accounting for the fymptoms of the dif- eafe. For, if like the the contagion of the fmall pox and venereal difeafe, the canine virus enters the circulation, it would affect the arterial fyftem, and produce an inflammatory ftate of the whole body. The pulfe, would then become full and hard, the heat increafed, and thefe fymptoms would be accompanied by others which are well known to occur in inflammatory difeafes. None of thefe fymptoms, however, are obferved to appear in the prefent difeafe ; and the hiftories of nume-, rous cafes inform us, that the pulfe is weak, quick, | and intermitting, and that a fever feldom or ever oc- curs*. The blood alfo, when drawn from perfons labouring under the fmall pox, or any other in- flammatory difeafe, feldom fails to be covered with a buffy coat or Jizc, but this has never appeared , in any cafe of the prefent difeafe; for repeated ob- fervation • Salius Diverfus, de feb. peft. p. $8. Sauvage fur la rage, p. 37 Vaughan's Cales, p. 29. r 7° l fervation has fliewn that it is no ways different from that drawn from a perfon in health*. Independently of the want of fimiliarity, in the fymptoms of the difeafe produced by the canine vi- rus, with thofe which originate with an abforbed poifon, the very great difference in the periods, at which the prefent difeafe appears, militates strong- ly againft the idea of abforption. In every cafe of the tranfmiffion of a poifon into the fyftem, through the medium of the lymphatics, the greatest uniformity is obferved. The fmall pox and venereal difeafe, have each their particular, and determinate periods of attack, from which they rarely depart in any climate, or constitution; but the canine poifon is greatly influenced by both thofe circumftances, and has been known to infect, in all the intermediate periods, between the firft day of a bitef, and nine- teen months afterwards +\ If the abforption of the poifon be rejected, the ftories related by Palmarius, of the difeafe being communicated by kifling a patient ill with the difeafe, muft be without foundation. Nay, Ds. * Philof.Tranfaa. vol. III. p. 276. Ibid. Vol. XLVII. p. 413. Morgagni, letter VIII, art. 30. -f- Edinb. Med. Com. Vol; XI. p. 304. X Philofoph. Tranf. No. 445. [ 7« 1 Dr. Vaughan has proved by actual experiment, the freedom from a morbid affection, in the faliva of a j human perfon. He inoculated a dog with fome, \ which was taken from a patient in this difeafe, but without producing any effect. He alfo fays, that a nurfe who was constantly with the child, whofe cafe he relates, often kiffed it, and received its breath full in her face, without any bad confe- quences. A perfon alfo ufed to put his finger into the mouth of Dr. Munckley's * patient, in or- der to extract the vifcid faliva, and felt no ill effect from the practice. But when we fee that other poifons, whofe abforption no one doubts, are not propagated by the blood or its fecretions, as the fmall pox, and venereal difeafe f, which have never been communicated by inoculation with the blood or any of its fecretions, why fliould it be cre- dited as occuring in this difeafe, where there are fo many probable arguments againft the abforption of the virus % ? 2. As to the propagation of the difeafe by the air drawn into the lungs; nothing at firft fight feems more * Med.Tranf. Vol. II. p. 46. f Hunter's Vreatife on Ven. Dif. chap. i. fecli, X This freedom from infection in the fecretions extends alfo to brute animals. A whole family nigh Chefter-Town, Maryland, drank the milk of a cow, and the negroes on a farm ate the flefh of feveral hogs which died of this difeafe, without experiencing any inconvenience. Dr. Rufh's Lectures. L 7* J more improbable. If it were poffible for the poifon to affume an aeriform ftate, of which, however, we have no proof, and be carried into the lungs ; it would be expelled again in expiration; or if, by mix- ingwiththefaliva, it were conveyed into the ftomach and bowels, its activity would be immediately deftroyed by undergoing the digeftive procefs. Other poifons, in a folid form, have been fwal- lowed without any injury ; as that of the venereal difeafe*, fmallpoxf, plaguej, viper||, ticunas §. The fuppofition of the difeafe being produced by mere contact of the faliva, being founded on the idea of abforption, needs no particular refutation, as I hope I have proved that no abforption takes place. It now becomes neceffary for me to determine the mode of the introduction of the poifon, and its manner of action on the fyftem. / In the firft place, I deem a wound abfolutely neceffary for its operation. From a confideration of * Hunter's Treatife on Ven. Dif. part vi. chap. i. t Rufh's Inquiries, append, p. 7. J Philofoph. Tranf. No. 370. || Mead's Works, p. 37. % Bancroft's Hift. of Guiana p. 300, Lond. 1769 L 73 i of the fymptoms and nature of the difeafe, I am difpofed to embrace the idea of the operation of the poifon on the nerves, and think it can be better fupported, than that of any other theory, hitherto offered. The poifon, as existing in the faliva, when in- ferted by a wound into a part of the body, lies dor- mant for fome time, and at length in various peri- ods, in different perfons, begins to ihew its effects on the fyftem at large. This opinion or the action of the poifon on the nerves, is fupported by the ftrik- ing analogy fubfifting between the prefent, and other nervous difeafes, particularly tetanus .* K i. In " Morgagni feems to entertain the fame idea, with refpect to the action of the poifon on the nerves; he remarks, "from the pro- " greftion of the pain upwards, and from what Salius obferved it to " terminate in, a certain confufion, unfteadinefs, and weaknefs of " mind, the virus does not feem to be carried through the veins (by " which veffels in his time, itwasthought abforption was perform- ed) but by the nerves up to their origins. Letter VIII. art. ^32. Dr. Percival alfo afcribes the difeafe entirely to " nervous irrita- tion." Eluiys, vol. ii. p. 369—and Dr. Vaughan fays, "we muft *' feek for the action of the poifon folely in the nervous fyftem." Cafes and Obf. on Hydrop. p. 51. C 74 I i. In both tetanus, and the difeafe confequent on the action of the canine virus, we may obferve, that the fame affection of the throat takes place, and the fame morbid fenfibility over the whole body, 2. The pain at the pit of the ftomach, and the rigidity of the mufcles of the abdomen, which are fuch constant fymptoms in tetanus, likewife occur in the prefent difeafe. 3. In both thefe complaints, we may obferve the fame affection of the urinary organs, the fame freedom from difeafe of the arterial fyftem, and laftly, the fame tendency to putrefaction, in the bodies of thofe who die of the difeafe. Morgag- ni * and Sauvage f make this remark on thofe who die from the bite of a rabid animal: and Dr. Rufh mentioned in his lectures, a cafe com- municated to him by Dr. Hahnbaum, of South Carolina, of a negro boy, who died of a tetanus, becoming fo putrid, that it was thought unfafe to open him, a few hours after his death. But the paralytic affections, { and numbnefs, (J which have feized the bitten limbs, and the dimnefs of * Letter viii, art. 23. f Nofolog. method, vol. i. p. 354, X Mead's works, p. 661. J| Med. Effays, Edinb. vol. v. part ii, p. 27. r 75 s of fight *, and fomctimes total blindnefs f, with- out any vifible fault in the eyes, which are well known fymptoms of nervous difeafes ,|| admit not the leaft room, or fufpicion for doubt, as to the action of the canine virus on the nerves. It was aliened, that the poifon remained long dormant in the part where it was firft inferted, and afterwards brought the whole fyftem into fympa- thy. This, I apprehend, can clearly be proved. We fee the fame thing every day in other cafes where topical affections of nervous and other parts, remain long without affecting the whole fyftem, until the application of fome caufe renders them manifeft. Dr. Percival §relates the cafe of " a lady, who " had received a bruife on the osjacrum, by a fall " when flie was young : fhe foon recovered from " its effects ; but eighteen years afterwards, the " rheumatifm fixed on the part, was attended with " unufually excrutiating pain, and long resisted the " remedies commonly employed, with much more " fpeedy fuccefs, in that diforder ." In a cafe of K 2 obfti- " Med. Commun. vol. i. p. 214. f Lond. Med. Enq. and Obf. voL iii, p. 3^8. || Whytt's works, 410. p. 622. S Percival's effays, vol. ii. p. 370. [ 76 J obftinate head-ach, on which Dr. Rufh * was con- fulted, it came on 18 months after the stroke which eaufed it had been received ; and my kinfnian, Dr. Andrew Meafe, obferved when the influenza pre- vailed in the place of his refidence, " that af- " fections of the abdominal vifcera, which had long " lain dormant,were refcufcitated by the difeafe."f Cafes of a fimilar nature, are frequently met with in practice, and in which there fubfifts a morbid local affection of certain parts, which are after- wards rendered manifeft on the application of particular caufes. That the virus in the prefent difeafe, remains local in the part where it was firft inferted, until the fymptoms are produced, is confirmed by this fact, that perfons have undergone general difeafes, and the operation of general remedies fubfequent to the bite; and yet the virus has afterwards fhewn its effects on the fyftem. Thus, there are repeated inftances of perfons having taken mercury as a preventative of the difeafe, and notwithftanding they had their fyftems fully impregnated with that mineral, have afterwards been feized with the dif- eafe. * Rufh's lectures. f Med. Commun. vol. i. p. 23. C 77 J eafe *. Mr. Nourfe f alfo informs us, that he cut a boy for the ftone, feveral months after receiving a bite, and never faw a wound more difpofed to heal than in that cafe: the boy was abroad in five weeks after the operation, and yet was afterwards affected by the difeafe. Van Swieten f alfo takes notice of the local nature of the virus, and fays, " it " feems very furprifing, that the moft confiderable " changes that can be made in our humours,fhould " be fo often neither able to expel the infection, nor " yet move it into action." Thofe, alfo, who have the misfortune to be bitten, perform all their func- tions equally well, as when in the moft perfect health ; until the poifon comes into action : there can, therefore, be no doubt but that it remains in the part where it was originally inferted, until the application of feme caufe favours its producing the difeafe. PR OX- * Med. Obf. and Enq, vol. v. appendix, p. :. Ibid, vol. iii. p. 356. Slamilton's remarks, p. 49. Med. Comment, vol. iii. p. 290. Philof. Tranf. No. 453. f Comment, on Boerh. aph. 1137. C 73 J PROXIMATE CAUSE. When treating of the action of the poifon, I afferted that its operation was on the nerves, and fupported this opinion, by the confideration of the fymptoms being fimilar to thofe which occur in other cafes, where thofe organs of the body are the feat of difeafes. I deferred fpeaking of the peculiar manner in which the virus produced its fpecific ef- fects, until this place, and nowpropofeto enquire in what manner, or by what operation on the nerves, the poifon excites the fymptoms of this difeafe ? To attempt to determine the principle communi- cated to the nerves, by which the poifon produces this difeafe, would be impracticable ; all that we know of it,is from its effects: I affert,then, that the virus induces a general debility of the nerves, and deprives them of their healthy tone, and the cufto- mary energy, which they had over the whole fyftem. Eut, it may be alked, In what manner does the poifon act ? Is it by a direct operation that it produ- ces its effects?-and on which the indications of cure are grounded: or, is it by indirect means, that it excites the difeafe ? Those L 79 ] Those who acknowledge themfelves profelytes of the ingenious Bruno, will at once determine the canine virus to be endowed with a ftimulating qua- lity, as that author has all other poifons and con- tagions *; and if they agree with me in my proxi- mate caufe, will explain its mode of action, and the fymptoms induced, on the principle of its inducing that debility, depending on the application of ex- ceffive Jlimulus, and therefore denominated indirect', in contra-diftinction to that, proceeding from the abftraflion of ufual ftimuli, termed dirccl. But, although I firmly affent to the idea of the stimulant action of thofe contagions and poifons, which enter the fyftem, in confequence of abforption by the lymphatics, as the fmall pox and venereal difeafe ; yet as I have fully proved the impoflibility of ac- counting for the fymptoms of the prefent difeafe, on that principle, and cannot find the idea of the ftimulant power of the poifon, to be fupported by the phcenomena exhibited by the difeafe, I inall offer fuch arguments, as in my opinion, tend to in- validate the general application of the affertion. i. If the virus producing this difeafe acted as a ftimulant, even granting that it induced indirect debility, it muft be evident, on the feme principle that accounts for this mode of action, that previ- oufly * Elements of Medicine, feet. xxi. I 80 ] previously to the induction of this ftate, the virus muft exert its ftimulant effects on the fyftem, which will be fhown by the production of a general in- termediate excitement. The fymptoms confeqtrent- ly following, would be fimilar to thofe that accom- company other difeafes, where this preternatural excitement is obferved to take place, and the func- tions of the nervous fyftem would be performed with greater force and energy in confequence of the vigour induced in it by the stimulant opera- tion of the virus. Thus, in maniacs, where from other caufes than a poifon, the nerves are under this preternatural tone, we obferve a furprifing in- creafe of strength,1 great infenfibility to cold, fero- city of difpofition, and constant delirium : White, on the contrary, in the prefent difeafe, the moft 6p- pofite fet of fymptoms are obferved from the be- ginning ; as great timidity *, extreme fenfibility to cold, or the leaft variation in the temperature of the air, great languor and prostration of ftrengthf, the * Hence patientsin this difeafe were called pantaphobi. f Dr. Mead has related the cafe of a man, who, in aconvulfive p&tfxyfm of his difeafe, broke all the cords with which he was bpuod to the bed; but this is the only inftance to be found of fuch apraicnt ftrength taking place ; and even if it were a con- ftant fymptom, the action of the poifon in producing debility, would not be invalidated, as the fame increafe of ftrength is ob- ferved in hyfteric, and epileptic girls, who although, when in health, are extremely weak, yet uill require feveral ftrong men to hold them, whenfeized with an&ccute attack of thofe complaints1.-'* r 81 ] paralytic affections *, great difficulty of breathing, and a variety of other fymptoms, which are well known to accompany difeafes depending on a de- bility or relaxation of the nerves. If the poifon acted by inducing indirect debility; during the ftate of excitement which muft neceffarily precede, debilitating remedies would be ferviceable, and by preventing the progrefs to indirect debility, fliould cure the difeafe. But bleeding, and other evacuating remedies, have been ufed in every pe- riod of the complaint, and melancholy expe- rience proves the injury fuftained by their ufe. It is therefore by a direct debilitating opera- tion on the nervous fyftem, that I fuppofe the virus to act in producing the difeafe. I well know it con- tradicts the theory of the above mentioned author, in whofeopinion,all things in nature are ftimulantf; and who alfo affcrts that thofe caufes which are of a debilitating nature, do not poffefs any pofitive power, but become hurtful by poffeffing a lefs degree of ftimulus than is neceffary to support animal life. This opinion, however, to me appears very erroneous; for there are many things capable of acting as di- rect fedatives on the human body, which do not contain a particle of ftimulus. Of the truth of this L affertion * Meads's works, p. 661. Philofoph. Tranf. Vol. III. p. 280. Med. EOays, Edinb. Vol. V. partii. p. 27 f Element. Med. Sect. XXXI. L sa ] affertion, nitre is a very remarkable instance. The univerfal ufe of this medicine, and the benefit do- rived from it, in inflammatory difeafes, is afuU proof of its direct fedative properties. If it produced the least ftimulant effect, however fmall this may be, it muft add the proportion oj that ftimulus to thejyftem., and confequently increafe the inflammatory diathe- sis already exifting. After taking frequent dofcs of this medicine therefore, the difeafe, which it was intended to remove, would be increafed. It fhould alfo prove ufeful by the fame ftimulant operation, in difeafes of weaknefs, although only in a fmall degree; but the direct reverfe of both thefe takes place, and from the moment it is taken into the ftomach, and fhews any operation, it does not increafe the force or frequency of the pulfe a fingle stroke, but produces a diminution of both. It creates at the fame time, a fenfe of coldnefs in the ftomach; and if its ufe be long continued, thefe fymptoms are fucceeded by the total deftruc- tion of the tone and vigour of that effential organ to our exiftence. There are many other medicines which ap- pear topoffefs a direct fedative power on the fyftem, and whofe effects from their firft operation are followed by debility, without the leaft stimulant ef- fect whatever. Exclusive [ «3 ] Exclusive of the arguments, in favour of the difeafe depending on a relaxation, or want of cuf- tomary energy in the nerves, derived from a con- fideration of the fymptoms; other poofs fhall be ad- duced of the truth of the fame opinion, which I fhall refer to the following heads. I. Predifpofing caufes. II. Analogy of the difeafe with Tetanus. III. The injury of debilitating remedies. i. That the difeafe originates from ageneral re- laxation of the nervous fyftem, I conclude from its production being favoured, and its power increafed by the exiftence of debility,"whether it be natural, and depends on peculiarity of organization, or ac- quired by the application of debilitating caufes. (i.)The original debility of constitution,has a very confiderable fhare of the influence in the pro- duction of this difeafe. When fpeaking of the caufes of the comparative early, or late attack in different perfons, I endeavoured to prove, that the variety in the time of the appearance of the fymp- toms, was proportioned to the fenfibility of the nerves. This alfo, in my opinion, is in a direct ra- tio to the debility that prevails in thofe organs of [ 84 1 I do not mean by this affertion to favour the uni- verfality of Dr. Brown's idea reflecting the exci- tability of the fyftem being always proportioned to the direct debility exifting, and vice verfa. For, al- though this principle is true, when applied to the nerves, and receives full confirmation from tetanus and the prefent difeafe ; yet I am far from thinking it a general rule, as the idea, in a great number of the difeafes of the arterial fyftem, is contradicted by experience. In typhus, where there is the greateft direct debility, a very powerful stimulus is required to produce any fenfible operation; while,onthe con- trary, a very flight ftimulus will aggravate an in- flammatory complaint*. •When I fay, however, that the fenfibility of the nerves is proportioned to their relaxation, or want of tone, I mean to confine myfelf, to their natural ftate; for when they are morbidly affected, the experience oitenanus fhews, that however fen- fible the superficies of the body may be, to external stimuli ; * It may be faid, in oppofition to this doctrine, that in palfies, where there is great want of tone in the nerves, there is alfo a defett of fenfibility. But I would obferve, that befides the want of tone, or morbid ftate of the nerves, they are alfo deprived of fome principle, on which their power of communicating fenfatioa depends, and of which we are altogether ignorant. [ 85 J stimuli; yet that it requires a very powerful internal stimulus, to produce even a flight imprejficn, and to counteract that, under which the nerves already labour. This law of the fyftem,. is fo univerfal, that I fcarce know an exception to it. Women, and boys, both of whofe conftitutions are very generally much debilitated ; and, as formerly remarked, have their nerves very eafily excited, likewife are affected with this difeafe, at a much earlier pe- riod than men, in whom, from their poffeffing a greater degree of ftrength and lefs fenfibility of nerves, the poifon requires a much longer time to come into action. Old people, alfo, whofe nervous fyftems have loft their ufual tone, poffefs a very great degree of fenfibility, and are affected in a violent manner by certain ftimuli, which in others, not fo advanced in life, or in themfelves fome years before, would have produced no operation whate- ver. Hence the reafon, why a few glaffes of wine will inebriate a man, in the decline of life, who previously to pafllng his acme, would have borne a bottle without intoxication. (2.) Tsie caufes concerned in the production of acquired [ 86 1 acquired debility, may be divided into external and internal: The external, are violent heat and cold ; the in- ternal, are, i. debility from previous difeafe; and, 2. depreffing paffions of the mind. I formerly treated of the effects of heat in the production of a general debility, and confequent proportional fenfibility of body, and therefore no- thing need be adduced on that fubject. Indeed, the fact is fo well known, that it only requires to be mentioned, in order to be at once affented to. I fhall therefore proceed to treat of the effects of cold in producing this debility, which proves a predif- pofing caufe to the difeafe. Although the effects of heat and cold, are known to be directly opposite, when applied in a moderate degree, yet it is no lefs certain, that they are attended with fimilar confequences, and produce the fame debility when applied in an ex- ceffive degree. The operation of cold, however, in the production of a predifpofition to this dif- eafe, only refpects brute animals. For, the people who inhabit cold climates, by means of heated ftove-rooms, the ufe of stimulating diet *, and of fur * Such as frozen fifh, fried in rancid whale oil, in which the greater! part of the diet of northern nations confifts. L 87 ] fur cloathing derived from the animals, with which Providence has kindly ftockcd their country, prevent the occurrence of that exceffive debility, which the cold has a constant tendency to produce, and which, without the above precautions, would inevitably enfue. The effect of this debility, however, is feen in other animals, which from not being poffeffed of the neceffary means to prevent the action of cold on their bodies, are as liable to the difeafes as thofe of warm climates *. Proofs of the influence of exceffive cold, in producing the difeafe among dogs and other animals, having been formerly adduced, I fhall proceed to treat of the internal caufes concerned in the induction of the ac- quired debility mentioned, which was, firft, by Previous Difeaje. I Have already, as I hope, proved, that a general debility of the nervous fyftem, when not morbidly affected, is always accompanied with a proportional excitability, or difpofition to be act- ed on by external ftimuli. It has alfo been fre- quently * Notwithftanding the means made ufe of by the inhabitants of northern climates, to prevent the 'violent effects of cold, vet they arc not fufficient entirely to prevent their occurrence in a certain degree. Thefe appear in the fmallnefs of the ftature of both man and beau, and the aftonilhing Uownefs in the ontraction of die heart, v\hidi does not produce more than half the number of puliation, that are perceived in an inhabitant of a more temperate cImuU [ 88 J quently mentioned, that in this difeafe, this difpofi- tion or principle of the body occurs in a remarka- ble manner. It will readily appear, therefore, how the debility which fucceeds difeafes in general, fliould poffefs fuch a confiderable influence, in fa- vouring the appearance of the difeafe, as it has ac- tually been found to have. This will be rendered still more apparent, when it is confidered, that this debility or relaxation, is univerfally of the nervous kind, and is alfo accompanied with the fame morbid fenfibility of the nerves. Hence the impreffions from external objects, which in health would fearcely be noticed, produce the moft difa- greeable effects, as frequent ftartings, or flight con- vulfions. Many cafes might be adduced, where this de- bility which fucceeds difeafes, has proved a predif- pofing caufe to this and other nervous complaints ; but a few only fhalhbe mentioned. On the recovery from a fevere illnefs, and af- ter fome flight irregularity of conduct, a tetanus has been frequently brought on, and in this cafe very commonly proved fatal. Of this Dr. Mofeley* gives us a remarkable inftance. Many women have * Difeafesof Tropical Climates, p. 485. 1 r »9 i have dated the commencement of an involuntary difpofition to faint, apd an immediate attack of the hysteria, on the leaft fudden furprife, which has continued to afflict: them the remainder of their lives ; to a fright received during their convalc- fcence after fome difeafe, or in the very excitable ftate fucceeding parturition. A melancholy cafe of a fatal locked-jaw, fell under my notice in this city, during the fummer of 1787, in a lady, by being awakened out of her fleep, by the fudden arrival of her hufband in the night. She was na- turally poffeffed of an uncommon fenfibility of con- stitution, and had been affected with fymptoms of the puerperal fever for two days before the occurrence of the unhappy accident. How the general debility, which arifes, from previous difeafe, fliould favour the appearance of the prefent complaint, will be underftood, when it is confidered, that the nerves are then more liable to be affected by the irritation of the virus ; which was prevented from coming into ac- tion before, by the healthy tone and vigour which they poffeffed. The celebrated Cocchi * informs us, that he knew many who underwent the fmall pox fubfequent to the reception of the bite of a M mad f Bagni di Pifa, p-. 31^ Van Swieten's Comment, aphcr. 113 7. r $o 3 mad dog, and died of its effects after their recovery from the former difeafe. The fmall pox, it is well known, leaves the whole fyftem in a very debili- tated and relaxed ftate; and in children, or thofe not arrived at maturity *, a variety of difeafes, depend- ing on that caufe, frequently follow, efpecially fcro- phulous fwellings of the lymphatic glands, &c. i 2. The fecond of the internal caufes mentioned as producing debility, was deprefllng paffions of the mind. Such is the connexion fubfifting between the mind and body and the influence they mutually poffefs over each other, that they have been very aptly compared, by a facetious author |, to a coat and its lining; if you rumple the one, you rum- ple the other. The hiftory of medical cafes like- wife teaches us, that this obfervation is founded on experience. The reciprocal influence of thofe two. component parts of our nature over each other is fo very confiderable, that a difeafe of the bodvy is affected in a moft aftonifhing manner, by the ftate of the mind. The reverfe of this remark is equal- ly true. The plague affords a remarkable proof of * Thefe it was remarked, are endowed naturally with a "reater degree of fenfibility, than adult?. f Sterne. r <)■ ] of the affertion. But in no instance, is the remark ftiofe strikingly verified than in thofe difeafes which have their feat in the nerves. The propagation of thefe from the affections of the mind, is decifive in its authority, and tends alfo greatly to confirm the ideas advanced refpecting the prefent difeafe. The cafe of the children in the poor-houfe at Haerlem, among whom the epilepfy fpread, from a few others being admitted among them who were afflicted with that complaint, is well known. It yielded after fome time to the great Boerhaave, by the ju- dicious application of a remedy, fuited to operate on their minds, after the failure of a host of medi- cines prefcribed by other phyficians, and intended to act on their bodies. Dr. Whytt * alfo informs us, that frequently in the Edinburgh infirmary, women have been feized with hyfteric fits froih feeing others attacked with them. In the complaint, which is more particularly the fub- ject of this differtation, the influence of the the mind is no lefs remarkable. When formerly treating of the averfion from fluids, and the diffi- culty of fwallowing them, I mentioned the power of the imagination in continuing that fymptom; and the poffibility of overcoming it, by an act of volition. It has likewife been found that thofe M 2 perfons * Whytt's Works, p. 481. 4T0. L 92 ] perfons who, from a knowledge of the effects con- fequent on the bite of a mad animal, have conti- nued the apprehensions refpecting their fafety, or have been afflicted with grief, from any caufe, were much fooner affected than others, who either from ignorance, or inattention, have never fuffered the circumftance of the bite to dwell on their minds. In fome perfons, however, it muft be acknowledg- ed, that the difeafe has appeared in a fhort period of time after the bite, and who were entirely un- concerned about it; but this hasbeen, for the moft part, in thofe cafes where the fenfibility of the fyftem, either from age or idiojyncracy, has been adequate to the production of the fame effects, as the de- bilitating operation of other perfons continually re- flecting on the probability of their being afflicted with the difeafe. In the cafe of Dr. Munckley's * ' patient, the confequences of a fettled dread and fear, in bringing on the fymptoms, were very ob- vious. From the time of his being bit, until the pe- riod of the attack, he was afflicted with the greatest folicitude, and constantly laboured under the utmost anxiety of mind refpecting his fituation. A day or two previoufly to the appearance of the difeafe, he was obferved to be more than ufualy melancholy. Morgagni f relates the hiftory of an old man, who * Med. Tranf. Vol. II. p. 46. f Letter viii, art. 27. [ 9o J who had no fymptoms of the difeafe, although, bitten four four months before, until after receiv- ing fome very ill ufage. The boy, whofe hiftory is recorded by Dr. Dickfon, perceived no indifpo- tion until he heard that a perfon in the neighbour- hood, who had been bit by the fame dog as himfelf, died that day. A ftill greater proof of the effects of fear in bringing on this difeafe,-is derived from a knowledge of the fact, that an actual dread oj fluids, and convulfions at the mere fight of them, have come on by the influence of fear alone, and where the poifon was not in the leaft concerned. Dr. Percival * has given two remarkable cafes where the operation of mental impreflion, from a bite being inflicted by a fuppofed mad dog, pro- duced thefe fymptoms : and an inftance occurred in this city fome years fince, where the natural fears of a gentleman from receiving a bite, were increafed to fuch a degree, by the improper fug- geftion of his phyfician, that an adual dread of water took place, and continued for feveral days. Finding, however, that without the ufe of any re- medy, his apprehenfions were groundlefs, his rea- fon triumphed; and when he became convinced of his error, he laughed at his own credulity, and at the fright that was occafioned by the falfe prognof- tic of his phyfician. From » Effays Med. Philofoph. and Experiment, Vol.11 p. 368, [ 94 ] c: From a careful perufal of Dr. Nugent* s cafe* ec it may be difcovered, that imagination, and art " apprehension of danger, formed the chief of the " fymptoms which the Doctor attributed to real hy- " drophobia*." II. The fecond general argument adduced to prove that the difeafe, at prefent under confideration, de- pends on a debility of the nervous fyftem, was its analogy with tetanus. I take it for granted that noiie will doubt the nervous nature of tetanus ; but it may appear necef- fary to prove that it alfo depends on debility, before I make ufe of its analogy with the prefent difeafe, in order to fhew that the latter originates from the fame caufe. To attempt this, however, would be digrefling too far from my fubject. Indeed it would be unneceffary, as it has already been fo amply de- monstrated by Dr. Rufhf, who both by reafon* ing, and what is ftill more decifive, the fuccefs of the tonic plan of treatment, has rendered the matter beyond all doubt. I fhall therefore pro- ceed to make ufe of the fuppofition of tetanus de- pending on debility as art eftablifhed truth. In * Hamilton's Remarks, p. 225. fVide Medical Inquiries and Obfervations Philadelphia, 1789, p. 169 A clear and decided proof of the injurious treatment of the old practice, and the fuccefs of the tonic plan, may alfo be feen by re- ferring to a cafe related by the late Dr. Ilahnbaum, of Charlefton, which f 95 ] I* a former part of this differtation,. I noticed the firnilarity which prevailed between the fymp- toms of thefc difeafes ; and I fliall now add a few, of many more particulars, in which they agree. i. Both thefe difeafes prevail for the moft pan in warm climates and Jeajons, and both are propa- gated in different periods of time, after the applica- tion of their respective caufes, in proportion to the greater or lefs fenfibility of the fyftem. 2. Both are rendered more fatal, by the ufe of debilitating remedies. From the erroneous ideas entertained refpecting the pathology of thefe dif- eafes, the fpafmodic affections and convulsions ob ferved to occur, were attributed to an excejs of ftrength. The moft powerful debilitating remedies were accordingly made ufe of for their removal. But, inftead of this apparent ftrength being the confequence of too much vigour, it is actually the effect of a deficiency of ftrength. It is well known, that" in the greateft debility, and even a fliort " time before death, fpafms ana* convulfions are " wont whieh together with fome remarks I inferted in the AmericanMufeum, for Auguft 1791. For proofs and cafes of the fuecefs of the tonic plan of treatment in this difeafe, I would alfo refer to Mem. Lond. Med. Soc. vol. II. p. 108, 114.—Tranf. Royal Acad, at Vienna, Vol. I. in each of which feveral cafes of the efficacy of the-in. - gating mode of treatment are given. r 9« D "wont to occur.*" Notwithftanding I am in» debted to Dr. Boerhaave for this remark, the fame author was led into an error, by'the apparent ftrength fliewn by perfons labouriug under this difeafe, when he fays, that it fliould be confidered as " Jumme infiammatorius." Thefe convulfions do not arife " becaufe the force of the mufcles in " contracting themfelves is encreafed, but becaufe " the force of the antagonists is diminifhed .f" Hippocrates, likewife, very early has noticed the occurrence of convulfions after haemorrhages, and their uniform fatality. Hoffman appears to have been of the fame opinion, when he fays, " atonia " gignctjpajmos." So far are thefe fpafms and con- vulfions from depending on real excefs of ftrength, that they are evidently morbid, and deferve as much to be accounted fo, as the apparent debility which takes place m pneumonia, rheumatifm, or other in- flammatory complaints. In thefe, the patients can neither move hand nor foot; and forming our judgment from fallacious appearances, bark and wine might with the fame propriety be pre- fcribed to remove this debility; as bleeding and other evacuations to cure the apparent ftrength in the former difeafes. But * Boerh. inft. feet. 401. •fMorgagni Letter x. art. 20. C 97 I But that the fpafms and convulfions in tetanus depend on debility, requires no other proof, than the death and defiruction which have in every cafe followed thejedative mode of treatment, and the fpeedy return to health by the ufe of tonic or invi- gorating remedies.* From this view of the analogy fubfifting between tetanus, and the difeafe produced by the action of the canine virus on the fyftem, it muft appear, that although they are effentially different in their remote, they are very nearly related to each other in their proximate caufe. No doubt, the prefence of the virus in the one cafe, is the caufe of the greater permanency of the fymptoms in the difeafe produced by it, and may occafion fome pe- culiarity in the appearances, in addition to thofe which take place in tetanus. This, however, only fhews that the Jame effect can be produced by two N different * Although the injury of bleeding in the difeafe arifing from the action of the canine virus, has been fhewn by its uniform failure ; yet the other part of the argument cannot be made ufe of to prove ftill further, that debility is its caufe. 1 apprehend, however, that no other proof would be required ; notwithftanding no cafe can be produced of the fuccefs of tonics in the cure of the difeafe, yet the pro- bability of their utility will fcarce be queftioned after the fatality which has been fliewn to attend an oppofite mode of treatment, and their fuccefs in tetanus, whofe affinity with the prefent difeafe I have al- ready pointed out. I 98 ] different caufes, a circumftance which very fre- quently takes place in other operations of nature. No alteration, therefore, in the treatment of the difeafe depending on the canine virus, is neceffary frora that which has been proved to be fo fuccefsful in tetanus. The hiftory of other poifons alfo fhew that the fame ftate can be produced by two different caufes, and yet the fame remedies have been found neceffary. Thus, in thofe eruptive difeafes, whofe remote caufes are certain fpecific contagions, an in- flammatory diathefis is as certainly induced, as by expofure of the body to alternations of heat and cold. The fmall-pox and meafles afford a ftriking proof of this affertion. In thefe difeafes, ' no particular complexion in the treatment is derived from the prefence of the contagion, different from the Jyno- cha, or fimple inflammatory fever : Why, then, fliould the remedies of the difeafe produced by the canine virus vary from thofe ufed in tetanus ? The only difference fubfifting between the two difeafes, originating from contagion and the other fimple affections, is, that in the cafe oftheJmallpox, a lejs degree of the fame inflammatory ftate is in- duced than that which occurs in Jynocha; while, in the difeafe produced by the canine virus, the fame ftate which occurs in tetanus is alfo brought on, but [ 99 J but in a greater degree. In the Jmall pox, there- fore, a lejs ufe is required of the fame antiphlogiflic means which are proper in the fimple inflammato- ry fever; in the difeafe depending on the canine vi- rus, a more vigorous and extenfive exhibition is re- quired of the Jame remedies which are ufed in tetanus. III. The third and last argument advanced to prove that the difeafe depends on debility, was the injury of debilitating remedies. I have anticipated myfelf, however,on this head, by proving the truth of the affertion, when treating on the analogy of the prefent difeafe with tetanus. 1 fliall, therefore, defer fpeaking any thing further on the fubject at this time, efpecially as I fliall have occafion to prove the fatality attending their ufe, when I come to treat of the remedies hitherto ufed for the cure of the difeafe. i N2 METHOD C io© 3 METHOD of CURE. To eftablifh a general fyftem for the cure of this difeafe, two indications are immediately point- ed out. i. To prevent the poifon from being communi- cated to the fyftem. 2. To counteract, or overcome its effects, after they have began to appear. In order to anfwer the firft indication, there have been a variety of external remedies made ufe of. The firft to be mentioned is the excifion of the bit- ten part. Where the wound happens to be fo fi- tuated, that the part in which the bite was inflicted, can with propriety be cut out, every one will al- low, that this operation muft afford the greatest fecurity: it ought therefore always to be pre- ferred. But there are many circumftances which may concur to prevent its accomplifhment. The wound is often inflicted deep in a mufcu- lar part, where the excifion of fo much flefh would be attended with great inconvenience.— " Much time may be loft before the furgeon ar- " rives j the fufferer may long refift all folicitati- " ons r 101 j ** ons to fubmit to the knife; the wound may have " been inflicted on the face, or near fome large " blood veffel ; or there may be fo little probabi- " bility of the madnefs of the dog, as to render " it unjustifiable to fubject the patient to prefent " pain, or future deformity *." To the applica- tion of the cautery there are ftill more valid objec- tions. The intenfity of the pain attending the ope- ration would be fuch, as to prevent numbers front fubmitting to it; and the idea of this would ope- rate fo forcibly with many, that they would rather take the chance of efcaping the difeafe, than fuffer the protracted tortures of a hot iron. The idea of fubfequent deformity, alfo, would operate power- fully, and this alone would be an infuperable bar to its employment. The application of the cauftic, as advifed by many late writers, has failed in cafes where it had unequivocally the fairest trial, and therefore does not feem intitled to our faith. In the cafe of Ad- miral Rowley's fonf, to which I have had frequent occasion to refer in the courfe of this differtation, the cauftic was applied to the part immediately after the bite, and by the hand of the very judicious Mr, • Percival's Effuys, Vol. II. p. 375, f Hamilton's Remarks, p. 221. r io2 ] Mr. Hunter ; the difeafe neverthelefs came on, and, as ufual, proved fatal. Various other applications to the bitten part have been recommended. It may not, therefore, be amifs to take notice of a few of the moft noted, as it will ferve to reconcile the prejudices in favour of particular remedies, and excite perfons to the ufe of others, when that which they molt approve, may not be near at hand, at the time it is re- quired. The mercurial ointment is recommended by many, particularly Sauvage*. Red precipitate and fublimate has alfo been ufed-]-. Common fait has long fince been highly commended, and addi- tional proofs of its efficacy, have within a fliort time, been prefented to the public by Dr. Gale of Connecticut J. The folution of the common cauf- tic in water, has likewife been greatly extolled. To determine the fuperiority of thefe applications, would be impossible, as it muft be evident they all act on the fame principle, by raifing an inflamma- tion and fuppuration in the wound, and by pre- venting it from healing, caufes a difcharge of the virus with the pus from the bitten part. There * Sauvage Nofolog. Method, torn ii. p. 236. f Palmanus de morb. contag. p. 272. J. Newhaven, Connecticut Med Soc, Tranf. r io3 j There is alfo another application yet to be no- ticed which is intended to create a difcharge, but not by an inflammation, unlefs long continued: this is the ufe of a long continued stream of cold water, poured on the wound, from a confiderable height, from the mouth of a tea kettle. This plan was firft propofed by the benevolent Dr. Haygarth,. of Chefter, in England, and is ftrongly recom- mended by Dr. Percival*; it has likewife received the fanction of the late Dr. John Morgan, the ho- nourable Arthur Lee, efq. and Dr. Samuel L. Mitchcl, who feparately publiflied recommenda- tions of the practice in all the newfpapers of this country. I am difpofed likewife to entertain the moft sanguine hopes from a proper ufe of this fimple application, as none of the arguments men- tioned againft the ufe of the former applications can be applied to this; no fituation of the wound or part of the body on which it is inflicted, can be urged as a reafon for its omiflion. The poifon alfo we know exifts in a watery form, and there- fore, wre fliould reafonably expect that water would be its moft proper folvent. " The preference " given to cold water for the firft ablution is judi- " cious, and accords with the idea above advanced, " that the nerves are the parts alone injured by " the * Percival's Effays, vol. II. 372—3' X r 104 ] e£ the canine virus. They may thus perhaps be "* rendered torpid, and the virus may be greatly di- "• luted, or waftied away, before they recover " fuch fenfibility as to be capable of fuffering *' from its action. When this has been fufficiently " applied, warm water fliould be ufed, not only as " a better folvent, but to produce a flow of blood ; " which coming from numberlefs fmall veffels, may *5 J which it was ufed in the cure of the constitutional difeafe, two or three drachms rubbed into the bit- ten part, have been thought adequate to its re- moval ; and becaufe in thefe partial trials, it has failed of having the wiflied-for effect, it has been declared totally ufelefs. Instead, therefore, of this partial and feeble ufe of mercurial ointment, I would advife half an ounce to be rubbed in the throat three times a day. By thus applying it to the parts more imme- diately affected, the benefit of the unctuous quality of the ointment will be obtained, and the fpecific effects of the mercury fufpended in it, will alfo be exerted, and the morbid fenfibility of the throat, thereby leffened. The good effects I have feen derived from its ufe in the tetanus,* in relaxing the jaws, and leffening the difficulty in fwallowing, induce us to expect the greatest benefit from its ufe in the prefent difeafe. The * In a cafe of tetanus, which occurred laft winter in the Pennfyl- vania Hofpital, during the attendance of Dr. Rufh, halt an ounce of mercurial ointment rubbed on the throat, was attended with the moft beneficial effects in relaxing the jaws, which were fo obftinately clofed as to prevent the introduction of the leaft medicine or nou- rifhment. In the courfe of twelve hours, by the ufe of the ointment, the patient could eafily fwallow : from the omiflion of the ointment, the iyuiptoins again returned, and the cure was finally completed by large quciniuci of bark and wine. L 126 ] The influence of depreffing paflfions of the mind in producing the difeafe, was formerly fhewn to be very confiderable; they will of courfe certainly aflift in favouring its continuance. Every poffible care ought, therefore, to be taken, to preferve the moft equable and ferene temper, and the utmolt hope and confidence ought to be infpired. The idea of the propensity in the fick to bite, which may deter fome from affording the requifite attend- ance, has no foundation in truth. Syftematic wri- ters*, indeed terrify us with apprehenfions on this head : but the unjettered and candid hiftorians of real cafes of the difeafe affure us, that no fuch fymp- tom ever occurs. Melancholy experience having fo often taught us, that the effects of the poifon are power- ful ; reafon plainly points out, that in order to counteract them, active medicines fhould be ufed. The very large dofes of thofe I have recommend- ed, may feem alarming to fome ; and it may be ap- prehended, that the debility which I have conftitut- ed the proximate caufe of the difeafe, may not on- ly be removed, but a ftate of the body brought on, directly oppofed to the former, and which will re- quire contrary remedies. No apprehenfions, how- ever, need be fuffered on this account, as it is the ardor Jebrilis which Boerhaave efteemed fo necef- fary * Sauvage, Boerhaave and Van Swieten. t 127 ] fary to the cure of the venereal difeafe, or that kind of inflammatory diathefis, which Dr. Rufh * has alfo deemed effential to overcome tetanus, that, in my opinion, is aloneJufficient to counteract the effects of the canine virus on the fyftem. Un- lefs this be effected, no remedy will be fuccefsful. It is unfortunate that the enemy is obliged to be attacked on the moft unfair grounds : for, by the difficulty in deglutition, we are deprived of the very means which in moft other complaints re- main free for overcoming the difeafe : were this obstruction not in the way, I entertain no more doubt of the efficacy of the tonic plan of treatment, than every one muft do of the injury of a contrary practice. In the preceding pages it was fliewn, that notwithftanding the difficulty patients labour under in commanding the requisite mufcles to fwal- low, it can be in a great meajure furmounted by a ftrong exertion, the patients fliould accordingly be advifed to ufe their utmost endeavors to take free- ly of their medicines, as the only means of feccefs. But, as a fuccefsful practice can be the only test of the efficacy of any particular mode of treat- ment of a difeafe, it may be aiked, where are there any proofs of its cure by the remedies here recommended ? To this I would reply, that how- eve r * Med. Inq. andCbf. p. 172. [ 128 ] ever impoflible it may be to adduce cafes of their fuccefs in the cure, as I have never had an oppor- tunity of trying them ; yet I am happy in having it ia my power to adduce two, in proof of the pro- priety of the method of prevention I have advifed. The firft, was communicated to me, and afterwards to the public *, by Dr. William Wefton, of the parifli of St. Ann's Bay, Jamaica, in the number of the American Mufeum, fubfequent to the one in which I had inferred fome remarks on the difeafe, and had declared my opinion of the probable fuc- cefs of the tonic plan of treatment: the particulars are as follow ; " In January last, a negro boy was bitten in the " hand by a dog, to all appearance as mad as ever " I beheld one ; he alfo bit two fheep and was then " killed. Being called to the boy, a fhort time " after his receiving the bite, I immediately dilated " the wound, and filled it with ftrong mercurial Ci ointment, having in it a large proportion of com- " mon turpentine, which caufed it to inflame confi- " derably, and difcharge freely. Ialfogavehimbark "- in fubftance, with wine for eight days, gradually " increasing thedofe,curingwhichtime,not theleaft " fymntom of the difeafe appeared. Theboycon- " tinued * American Mufeum, vol. viii. n. ioo,—Sept. 1790. [ I29 I " tinued perfectly well when I left the ifland, which " was in July last. The two fheep, which yvere " bitten nearly at the fame time, died in ten days " afterwards, raving mad." The Doctor adds, " Although the forming a general rule for the " treatment of a difeafe from the fuccefsful termi; " nation of a fingle cafe cannot be allowed ; yet I "fhall be happy, if recording the above, fhall in- " duce a confidence in other practitioners, to give " the fame mode of treatment a fair trial, in this " difeafe, which I have no doubt will prove equally " fuccefsful in the cure with others, as it did in the " prevention of it with me." The other cafe alluded to, is one communicated to me by John Shore, M. D. of Peterfburgh, Vir- ginia, in a letter which I received from him, dated the 17th October, 1791. " On the firft of February i7Qi,a negro girl, " about 16 years of age, was bitten on the right R " fhoul- * The fuccefs in the above cafe was in all probability owing to the external or local treatment made ufe of; as from the (horttime that the bark and wine were given, it is impoflible to afcribe any of the good effeas to them. In order to have acquired any pretenfions to the prevention of the difeafe, they fhould have been continued a much longei time, and until the common period of the attack had pafled, as I have mentioned in the preceding ; a..- I C J3° ] " fhoulder in three different places, by a mad dog, " which at the fame time was feen to bite another " dog and a cow. They both ran mad, the cow " on the 21ft and the dog on the 28th of the fame " month. I flaw her the next day about 30 hours " after the accident, when I immediately directed " my whole attention to the wound, by making " upon it large and deep fcarifications, after which " the lunar cauftic was applied ; the parts filled " with ftrong mercurial ointment, and the whole " covered with a blister, in order to excite in- " flammation in the wound and to keep it open " as long as poffible, on which I conceived the " other, and ftill more important, part of the cure " depended. The mercurial friction was then direc- " ed in fuch quantities as to affect the mouth fpee- " dily, with the occafional ufe of opium to procure " fleep and reft ; after this, the tone of the fyftem " was perfectly reftored by continuing the ufe of " the bark and wine for fome time. No fymptom " has ever yet appeared, and I confider the girl as " quite fecure." THE END. ERRATA. Preface, page 2, bottom line, after the word " intended? add to relieve. Pages 12 and 14, in the notes-, for " Med. Com. vol. ii." read vol. xi. Page 15, line 9, for "put," read.puts. Page 42, line 13, for " it," read they. Page 77, the firft-dagger refers to the Philof. Tf anf. No. 445 •, the fecond fhould be a double dagger, and refers to Van Swieten's Com. Page 87,bottom line, erafe "external." Page 106, line 10,after *< experience" addrefpeclingthe. I Tj uv.iY n VTK'/l VI 4 J sdrnetM (./;dqfofjj>liifC 'tf ViQT£Wt\0f v: is raw v- ★ * ARMY * * MEDICAL UBRARY Cleveland Branch_____ ^ 'i&'Y m